457 The Impact of PAP Therapy on Hematocrit in OSA and Polycythemia: A Pilot Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A180-A181
Author(s):  
Mustafa Jafri ◽  
Gabrielle Rosa-Acosta ◽  
Jose Flores Martinez ◽  
Elizabeth Schofield ◽  
Cy Wilkins ◽  
...  

Abstract Introduction Untreated polycythemia leads to complications including thrombosis. Obstructive sleep apnea (OSA) is commonly associated with secondary erythrocytosis, which testosterone therapy can perpetuate. Effects of positive airway pressure (PAP) on elevated hematocrit (HCT) is unknown. We hypothesize PAP adherence can reduce HCT in men with OSA and polycythemia. Methods Retrospective chart review of male outpatients with newly diagnosed OSA and HCT≥45% at or 3 months before polysomnography (PSG) was conducted. Intervention group consisted of patients initiating PAP for OSA. HCT within 6 months of PAP initiation and PSG were recorded for intervention and control groups, respectively. Primary endpoint was time-to-HCT reduction of HCT<50% plus 3% decrease. Cox proportional-hazards analysis was used to assess time-to-HCT response. Demographics, smoking history, testosterone administration, STOP-Bang score, AHI, and PAP compliance data were obtained. Patients excluded if PAP not indicated, or if PSG, PAP compliance, or repeat HCT were unavailable. Results 41 men with OSA had HCT≥45%, of which 16 had HCT≥50%. Median age was 60 years and median BMI was 32 kg/m2. 28 started PAP. 21 met definition for PAP compliance within 6 months. Median AHI of intervention and control groups were 23 and 19 events/hr, respectively. Mean baseline HCT of both groups were 49 and 50, respectively. No significant difference in age, BMI, smoking history, testosterone therapy, and baseline HCT between both groups noted. 39% of intervention group exhibited HCT response at 1 or more longitudinal assessments, versus 38% of control. Intervention group had higher mean STOP-Bang than control (mean 5.9 vs. 4.6, p=0.01) and trended towards higher mean baseline AHI (27.4 vs. 19.0, p= 0.06). Time-to-event analysis controlling for STOP-Bang and AHI demonstrated PAP was not associated with time-to-HCT response (HR = 1.3, 95% CI = 0.4–4.4). In moderate-severe OSA patients, 40% of intervention group had HCT response compared to 14% of control, though difference was not significant (HR = 2.5, 95% CI = 0.3–20.0). Conclusion Moderate-severe OSA patients trended towards reduction in HCT with PAP, although not statistically significant. Testosterone administration did not affect HCT response to PAP in this cohort. Larger studies are required to determine HCT response to PAP in these patients. Support (if any):

2019 ◽  
pp. 1357633X1986890
Author(s):  
Miho Asano ◽  
Bee C Tai ◽  
Felicity YT Yeo ◽  
Shi C Yen ◽  
Arthur Tay ◽  
...  

Introduction The aim of this research was to evaluate the impact of a novel tele-rehabilitation system on self-reported functional outcomes compared to usual care during the first three months after stroke. Methods A parallel, two-arm, evaluator-blinded, randomised controlled trial was conducted. Adults aged ≥40 years who had suffered a stroke within four weeks of the start of the study were recruited from the general community. The intervention group received access to a novel tele-rehabilitation system and programme for three months. The primary outcome measures utilised were the frequency and limitation total scores of the Late-Life Function and Disability Instrument (LLFDI) at three months. Results A total of 124 individuals were recruited. The mean differences in the LLDFI frequency and limitation total scores at three months comparing the intervention and control groups were –3.30 (95% confidence interval (CI) –7.81 to 1.21) and –6.90 (95% CI –15.02 to 1.22), respectively. Adjusting for the respective baseline covariates and baseline Barthel Index also showed no significant difference between interventions in the LLFDI outcomes. Discussion The intervention and control groups self-reported similar improvements in functional outcomes. Tele-rehabilitation may be a viable option to provide post-stroke rehabilitation services in Singapore while reducing barriers to continue rehabilitation conventionally after discharge from hospital and encouraging more participation.


Author(s):  
Esmat Rezabeigi Davarani ◽  
Mohammad Reza Mahmoodi ◽  
Narges Khanjani ◽  
Mohammad Mehdi Fadakar

Background: We sought to evaluate the effect of educational intervention based on the theory of planned behavior (TPB) on nutritional behaviors in relation to the cardiovascular disease (CVD) among health volunteers. Methods: In this quasi-experimental study, the participants included 128 active health volunteers. To conduct the study, 65 and 63 participants were randomly assigned into the intervention and control groups, respectively. Data were collected before and six weeks after the intervention using a validated researcher-made questionnaire. The questionnaire consisted of demographic variables, knowledge questions, and TPB constructs. Data were analyzed by Chi-square, t-test, Mann-Whitney U, and Wilcoxon test. Results: No significant difference was observed between the intervention and control groups with regard to the demographic characteristics, knowledge mean scores, and TPB constructs at the beginning of the study. However, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control (PBC), and nutritional behavior increased significantly (P < 0.001, P < 0.001, P = 0.018, P = 0.007, and P < 0.001, respectively) in the intervention group six weeks after the beginning of study. Significant differences were observed in nutritional performance of the intervention group, in other words the nutritional behavior of the intervention group members changed during the intervention. Conclusion: The PBC was the strongest construct in attitude. To optimize nutritional interventions in preventing the CVD, TPB should be implemented in educational interventions.


2020 ◽  
Vol 13 (1) ◽  
pp. 73-87
Author(s):  
Mila Bulić ◽  
Ines Blažević

The research aimed to check for difference in learning motivation between students learning online and students participating in modern classroom instruction. The study participants included students attending grades 5 to 8, divided into experimental (online classes) and control groups based on pre-testing. The results show that there is no statistically significant difference in motivation between the tested sub-samples. Student motivation for learning natural sciences declines with their years of schooling, but this is not statistically significant. It can be concluded that online teaching of Science and Biology as a learning tool can be as motivating as modern teaching using active classroom methods.


2004 ◽  
Vol 122 (6) ◽  
pp. 252-258 ◽  
Author(s):  
Tathiana Pagano ◽  
Luciana Akemi Matsutani ◽  
Elisabeth Alves Gonçalves Ferreira ◽  
Amélia Pasqual Marques ◽  
Carlos Alberto de Bragança Pereira

CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients' quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE Of STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clínicas (Medical School, Universidade de São Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student's t test and Pearson's correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety.


2013 ◽  
Vol 26 (6) ◽  
pp. 574-579 ◽  
Author(s):  
Andrew Szkiladz ◽  
Katherine Carey ◽  
Kimberly Ackerbauer ◽  
Mark Heelon ◽  
Jennifer Friderici ◽  
...  

Purpose: Many health systems have implemented interventions to reduce the rate of heart failure readmissions. Pharmacists have the training and expertise to provide effective medication-related education. However, few studies have examined the impact of discharge education provided by pharmacy students and residents on patients hospitalized with heart failure exacerbations. Methods: This was a nonrandomized intervention study evaluating the impact of a pharmacy student and resident-led discharge counseling program on heart failure readmissions. The primary end point was the 30-day heart failure readmission rate. Secondary end points included self-reported patient understanding of medications, number of medication errors documented, and estimated associated cost avoidance. Results: A total of 86 and 94 patients were enrolled into the intervention and control groups, respectively. No statistically significant difference in readmission rates was detected between the intervention and the control groups. Thirty-four medication errors and discrepancies were documented, or 1 for every 2.5 patients counseled, resulting in an estimated cost avoidance of $4241 for the institution. Eighty-nine percent of patients who received discharge counseling agreed they had a better understanding of their medications after speaking with a pharmacy resident or student. Conclusions: There was no statistically significant difference in readmission rates; however, several medication errors were prevented, and a large percentage of patients expressed an improved understanding of their medications.


2018 ◽  
Vol 1 (1) ◽  
pp. 47-55
Author(s):  
Ali Nouri ◽  
Fataneh Esmaeilli ◽  
Saman Seifpour ◽  
Mahmoud Talkhabi ◽  
Anahita Khorami

This study is a mixed method design which employed both quantitative and qualitative methods in order to investigate the impact of dialogic learning on students’ attention and academic achievement. Data were collected using several instruments, including: the Attention Network Test; academic performance tests and semi-structured interviews. Results of Analysis of Covariance (ANCOVA) indicated that there is a statistically significant difference between the mean scores of students of the experimental and control groups on the executive control in favor of the experimental group after controlling the IQ score and pre-test scores. Further, there is a statistically significant difference between the mean scores of student of the experimental and control groups on the academic achievement tests (except of mathematics) in favor of the experimental group. The qualitative data also supported the quantitative findings. Therefore, dialogic teaching has significantly greater and more positive changes on some aspects of attention and academic performance.


2020 ◽  
Author(s):  
Parvin Allahyari ◽  
Mitra Kolivand ◽  
Arash Namdari ◽  
Khaled Rahmani

Abstract Objective: sexual desire is an integral part of an identity and character of a human being, that affect how to behave with spouse. This study aimed to study the effect of cognitive-behavioral counseling (CBT) on sexual compatibility of new married couples in Sanandaj City in 2018. Method: This was a randomized clinical trial study and participants were 80 new married couples whose information was recorded at the premarital counseling centers that were randomly divided into intervention and control groups. Intervention group received 8 weekly 120-minute sessions of group consultation with cognitive-behavioral approach. Data were collected before the intervention, after 8 weeks of counseling, and two months after the last counseling session using the National Sexual Compatibility Scale. Data were analyzed using chi-square inferential statistics and independent t-test or nonparametric Mann-Whitney test. analysis of covariance was used to control of potential confounders. Results: The mean values of sexual compatibility in two intervention and control groups before counseling were 94.20±3.30 and 93.41±6.84 respectively. These scores reached to 100.11±2.96 in the intervention group and 98.83±3.66 in the control group immediately after the intervention. Also two months after the end of counseling, this rate was 101.98±4.03 in the intervention group and 98.83±3.66 in the control group. The intra-group comparison of sexual adjustment scores before and after counseling and two months after the intervention, showed a statistically significant difference (P <0.001). The trend of changes in the control group was not significant (P >0.05). There was a significant difference between two groups in level of scores two months after the intervention (P <0.001). Conclusion: CBT was effective in improving the level of sexual compatibility between new married couples. It is recommended to use this method of counseling, along with other services provided at pre-marriage counseling centers, to continue and improve the quality of sex and vitality of couples.


2021 ◽  
Author(s):  
Fatemeh Keshmiri ◽  
Azam Hoseinpour

Abstract BackgroundThe aim of present study was to assess the effect of interprofessional education concerning interprofessional professionalism on learners' perception of the ethical climate of the operating room.MethodThe present study is quasi-experimental design. Learners include surgical residents, operating room technicians, and anesthesia technicians (n=130) that distributed to intervention and control groups. The objectives of the intervention were the development of competencies of ethics and professionalism (including communication, altruism, respect, and excellence). The educational strategy was interprofessional education and the main method of training was scenario-based learning. Participants completed the Olson Moral Climate Questionnaire before and one month after the intervention. We used descriptive tests (mean, SD, percentage), student t-test and ANOVA to compare the scores of learners in the intervention and control groups.ResultsThe results of the study showed that the scores of the learners in the intervention group 4.05 (0.31) improved significantly compared to the control group 3.35 (0.37) (P = 0.0001). The scores of learners in the domain of ​​“managers” improved higher and the domain of ​​physicians improved lesser than other domains. There was no significant difference between the three groups of residents, operating room, and anesthesia technicians in terms of moral climate scores.ConclusionIn the present study showed the positive effect of interprofessional education interventions on individuals' perceptions of the operating room ethical climate. It is suggest that educational interventions be planned and implemented continuously in the educational systems and hospitals.


2021 ◽  
Author(s):  
Pegah Mohammadzadeh ◽  
Elnaz Shaseb ◽  
Zohreh Sanaat ◽  
Parvin Sarbakhsh ◽  
Nasrin Gholami ◽  
...  

Abstract Purpose Peripheral neuropathy is a complication of taxane that in severe cases can limit the optimal treatment. The aim of this study was to evaluate the efficacy of memantine in prevention of docetaxel induced peripheral neuropathy in patients with breast cancer. Methods In this randomized clinical trial, 40 women between the ages of 18 and 64 years with non-metastatic breast cancer (stages I to III) were included (registry number: IRCT20160310026998N9 and registry date: 26 March 2019). All patients were treated with the AC-T regimen (with docetaxel). Patients in intervention group received memantine at a dose of 20 mg for 8 weeks at the beginning of the first cycle of docetaxel. Patients in control group did not take any medication for neuropathy prevention. To assess the neuropathy, DN4 and CTCAE questionnaires were used at baseline, one months, three months and six months after the intervention. Results The DN4 questionnaire score was remarkably less in memantine group in follow up one (p-value: 0.033) and three (p < 00.1). The CTCAE follow up score did not change during study. The Neuropathy duration and Neuropathy onset, were shown significant difference between the intervention and control groups, p = 0.050 and p = 0.001, respectively. From 40 patients, 8 (40%) in memantine group and 2 (10%) in control group, did not experience any kind of neuropathy. Conclusion Data showed that prophylactic administration of memantine 20 mg/day has been effective in prevention of severity and incidence of docetaxel induced neuropathy in patients with breast cancer.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Paria Amiri ◽  
Mojgan Mirghafourvand ◽  
Khalil Esmaeilpour ◽  
Mahin Kamalifard ◽  
Reyhaneh Ivanbagha

Abstract Background Pain control and the stress associated with labor and delivery are among the most important issues of health care system. Use of distraction techniques during childbirth is reported to reduce pain and stress of labor. However, there is a limited publication that looked on the effect of distraction techniques on labor pain and stress. Thus, the aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of childbirth, length of delivery stages, first minute Apgar score and oxytocin consumption (secondary outcomes). Methods A randomized controlled clinical trial was conducted on 68 pregnant women. Participants were allocated into two groups (intervention and control groups) by blocked randomization. Participants in the intervention group received distraction techniques in four sessions. Questionnaires of Fear of Childbirth (W-DEQ version A) and PSS once were completed before intervention and again at the 36th week for the W-DEQ and in the active phase for the PSS through interviews. The pain was assessed through VAS during active phase per hour. The length of delivery stages was recorded in the partograph chart. Data were analyzed by independent t-test and ANCOVA. Results The mean of perceived stress during labor in the intervention group was significantly less than that of the control group (AMD: -3.2; 95% CI: − 0.8 to − 6.0; P = 0.01). The mean (SD) of pain intensity during labor was less than in the intervention and control groups compare to the control group (6.2 vs 7.5; P < 0.001). There was no significant difference between the two groups in terms of fear of childbirth score (AMD: 5.3; 95% CI: 13.0 to − 6.0; P = − 2.3). Moreover, there was no statistically significant difference between the two groups in terms of the active phase of labor (P = 0.504), second stage of delivery (P = 0.928), total length of delivery (P = 0.520), Apgar score (P = 1.000) and frequency of oxytocin consumption (P = 0.622). Conclusion According to the results, distraction techniques can reduce the pain and stress of labor, but further studies by using the distraction techniques are needed to reach a decisive conclusion. Trial registration IRCT2017042910324N39; Name of registry: Iranian Registry of Clinical Trials; Registered 11 September 2017. URL of registry: https://fa.irct.ir/user/trial/10814/view. Date of enrolment of the first participant to the trial: September 2017.


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