Abstract 253: Out of Range INR Results Lead to Increased Health Care Utilization in Four Large Anticoagulation Clinics

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Geoffrey D Barnes ◽  
Xiaokui Gu ◽  
Eva Kline-Rogers ◽  
Chris Graves ◽  
Eric Puroll ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Thromboembolic Complication ◽  
Anticoagulation Clinic ◽  
Target Range ◽  
Control Group ◽  
Phone Calls ◽  
Adjusted Means ◽  
Anticoagulation Clinics ◽  
Lab Test ◽  
The Impact

Background: The impact on healthcare utilization of a single out of range (OOR) INR value not associated with any bleeding or thromboembolic complication among chronic warfarin-treated patients is not well described. Methods: At four large phone-based anticoagulation clinics in Michigan, warfarin-treated patients with atrial fibrillation (AF) or venous thromboembolism (VTE) were identified and data collected via medical chart abstraction. Propensity score matching was used to identify two groups closely matched on patient characteristics: the OOR INR group (INR value < 1.8 or > 3.2 if target range was 2-3) and the control group (INR value between 1.8 and 3.2). Data for each anticoagulation clinic interaction and INR lab test were abstracted until the patient had 2 subsequent and sequential in-range INR values. Methods and frequency of interactions between the anticoagulation clinic and patient were recorded, described as median and interquartile ranges (IQR) and compared using Poisson regression with adjusted means. Results: Demographics were similar for the 116 OOR INR patients and the 58 control patients studied (mean±SD age 72.1±13.0 and 74.3±11.3 years, respectively). Indications for warfarin were more commonly venous thromboembolism in the OOR versus in-range patients (42.2% vs. 27.6%, p=0.06). OOR and in-range INR patients experienced a median of 3 (IQR 3-5) and 3 (IQR 3-3) with adjusted means of 4.2 and 3.2 (p<0.001) INR lab draws until two sequential tests were in-range. OOR INR patients required a median 5 (IQR 3-6) with adjusted means of 5.3 and 3.7 interactions with the anticoagulation clinic versus 3 (IQR 3-4) for in-range INR patients (p<0.001). OOR INR patients more often required phone calls (adjusted means 2.9 versus 0.9, p<0.001) but fewer mailed letters (adjusted means 1.3 versus 2.3, p<0.001) than in-range INR patients. OOR INR patients more often required multiple types of contact than in-range INR patients (83.6% versus 55.2%, p<0.001). Contact was most frequently performed by registered nurses (adjusted means 3.4 versus 2.9, p=0.059) and administrative assistants (adjusted means 1.3 versus 0.5, p<0.001) for both OOR and in-range INR patients. Blood count and renal function lab test were similarly rare for both groups (mean 0.4, median 0, p=0.74 for each). Conclusions: Warfarin-treated patients who experience OOR INR values without any bleeding or thromboembolic complication require more frequent interactions with the anticoagulation clinic, including more telephone calls and multiple types of contact.

scholarly journals Evaluation of the online-based self-help programme “Selfapy” in patients with unipolar depression: study protocol for a randomized, blinded parallel group dismantling study

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rico Krämer ◽  
Stephan Köhler
Keyword(s):  
Depressive Symptoms ◽  
Depression Scale ◽  
Drop Out ◽  
Control Group ◽  
Hamilton Depression Scale ◽  
Online Interventions ◽  
Phone Calls ◽  
Self Help ◽  
Low Threshold ◽  
The Impact

Abstract Background Patients with mild to moderate depressive symptoms can have limited access to regular treatment; to ensure appropriate care, low-threshold treatment is needed. Effective online interventions could increase the supply of low-threshold treatment. Further research is needed to evaluate the effectiveness of online interventions. This study aims to evaluate the online-based self-help programme “Selfapy” on a sample of depressive subjects and compares the impact of the programme’s unaccompanied version with its therapeutic accompanied version. Methods A sample of 400 subjects that have a mild to severe depressive episode (Becks Depression Inventory - II and Hamilton Depression Scale) will be used. Subjects are randomly assigned to immediate access to an unaccompanied course (no support from psychologist via weekly phone calls), immediate access to an accompanied course (support from a psychologist via weekly phone calls) or a waiting list control group (access to the intervention after 24 weeks). The intervention will last for a period of 12 weeks. Depressive symptoms as a primary parameter, as well as various secondary parameters, such as life satisfaction, therapeutic relationships, social activation, self-esteem, attitudes towards Internet interventions and drop-out rates, are recorded at four different points in time: at baseline (T1), 6 weeks after the start of the intervention (T2), 12 weeks after the start of the intervention (T3) and 3 months after completion of the treatment follow-up (T4). Conclusion This randomized and controlled, blinded study will make use of a “dismantled” approach to adequately compare the accompanied and unaccompanied versions of the intervention. Positive and meaningful results are expected that could influence the acceptance and implementation of online interventions. Trial registration German Clinical Trials Register DRKS00017191. Registered on 14 June 2019

PHARMACEUTICAL CARE OF ADOLESCENTS WITH DIABETES MELLITUS TYPE 1: THE DIADEMA STUDY, A RANDOMIZED CONTROLLED TRIAL

2015 ◽  
Vol 101 (1) ◽  
pp. e1.67-e1
Author(s):  
Emina Obarčanin ◽  
Manfred Krueger ◽  
Petra Mueller ◽  
Verena Nemitz ◽  
Holger Schwender ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pharmaceutical Care ◽  
Intervention Group ◽  
Well Being ◽  
Diabetes Mellitus Type ◽  
Control Group ◽  
Randomized Controlled ◽  
Phone Calls ◽  
The Impact

BackgroundAdolescents with type 1 diabetes mellitus (T1DM) often show low adherence to complex insulin regimens, leading to poor glycemic control. The benefit of pharmaceutical care in adults with diabetes mellitus type 2 (T2DM) has been widely explored; however, evidence in adolescents with T1DM remains scarce.ObjectiveTo evaluate the impact of pharmaceutical care in adolescents with T1DM provided by a multidisciplinary team on multiple important clinical outcomes.SettingAt the outpatient Helios Paediatric Clinic and at the 12 regular community pharmacies of the study patients with 14 pharmacists in the Krefeld area, Germany, and at the University Pediatric Clinic with one pharmacist on-site in Sarajevo, Bosnia-Herzegovina.MethodsA randomized, controlled, prospective, multicenter study in 68 adolescents with T1DM. The intervention group received monthly structured pharmaceutical care delivered by pharmacists plus supplementary phone calls for 6 months. The control group received usual diabetic care. Data were collected at baseline and after 3 and 6 months. In addition, HbA1c was measured after 12 months.Main outcome measures The between-group difference in the change from baseline in glycosylated hemoglobin (HbA1c), the number of severe hypoglycemic events in both groups, and patient well-being in the intervention group.ResultsThe improvement from baseline in HbA1c was significantly greater in the intervention group than in the control group after 6 months (change from baseline −0.54 vs. +0.32%, p=0.0075), even after adjustment for country-specific variables (p=0.0078). However, the effect was more pronounced after only 3 months (−1.09 vs. +0.23%, p=0.00002). There was no significant between-group difference in the number of severe hypoglycemia events. After 6 months, the well-being according to the WHO-5 index in the intervention group increased significantly from 52.8% to 63.3%. After 12 months the mean total HbA1c remained significantly reduced in the intervention compared to the control group (8.6% vs. 9.5%, p=0.0184).ConclusionThe improved outcomes seen in this study provide new evidence that pharmaceutical care adds value to the management of T1DM in adolescents. However, the optimal methods of achieving sustained long-term improvements in this specific patient population require further study.

scholarly journals Technology in action: Ascertaining the impact of cell phone calls on middle school students placed at risk of drop out

2020 ◽  
Vol 13 (40) ◽  
pp. 4224-4233
Author(s):  
Naseem Hyder Rajput
Keyword(s):  
Middle School ◽  
At Risk ◽  
Middle School Students ◽  
Cell Phone ◽  
Drop Out ◽  
School Level ◽  
Control Group ◽  
School Students ◽  
Phone Calls ◽  
The Impact

Background/Objectives: Regular attendance at school is essential for allround development of students. The fundamental objective of this study was to utilize low-cost technology of cell phones to report to parents/guardians about the attendance of their children at schools and ascertain the impacts of cell phone calls on the attendance of Middle School students placed at risk of Drop out. Methods/Statistical analysis: This study was Experimental with a PretestPosttest Control Group by design and descriptive by purpose. The participants were 30 eight graders belonging to a Public Middle School of District Shaheed Benazirabad in Pakistan. These participants were then randomly assigned to Control and Experimental Groups (15 each). For intervention of making cell phone calls to parents/guardians to inform and ask them about the reason for the absence of their child, a teacher in each participating school was assigned this responsibility. The intervention lasted for 3 months. The data was analyzed using SPSS repeated measure t-test to calculate the significance of the impact of intervention. Findings: Results of the present study indicated that the attendance of Experimental Group on Posttest (75.07 %) was significantly higher than that on Pretest (62.87%). Novelty : This study utilizes existing technology available to almost everyone and bridges the parents and school administration to get the best outcome quickly; mobile-based intervention is simple and docile to regulate students’ performance at school level; it also improves the safety of the students.

scholarly journals The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial

10.2196/18174 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e18174
Author(s):  
James Brief ◽  
Anupama Chawla ◽  
Diana Lerner ◽  
Bernadette Vitola ◽  
Robert Woroniecki ◽  
...  
Keyword(s):  
Arrival Time ◽  
Controlled Trial ◽  
Smartphone App ◽  
Control Group ◽  
Phone Calls ◽  
Significant Difference ◽  
Patient Arrival ◽  
Colonoscopy Preparation ◽  
The Impact ◽  
Pediatric Colonoscopy

Background Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. Objective The aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. Methods In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. Results App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75% (15/20) of app users and 41% (9/22) of written instruction users had preps categorized as “excellent” on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50%], written instruction users 8/22 [36%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56). Conclusions Smartphone app use was associated with an increased number of colonoscopy preps classified as “excellent” on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure. Trial Registration ClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105

scholarly journals The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
James Brief ◽  
Anupama Chawla ◽  
Diana Lerner ◽  
Bernadette Vitola ◽  
Robert Woroniecki ◽  
...  
Keyword(s):  
Arrival Time ◽  
Controlled Trial ◽  
Smartphone App ◽  
Control Group ◽  
Phone Calls ◽  
Significant Difference ◽  
Patient Arrival ◽  
Colonoscopy Preparation ◽  
The Impact ◽  
Pediatric Colonoscopy

BACKGROUND Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. OBJECTIVE The aim of this study is to determine if an app (<i>SB Colonoscopy Prep</i>) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. METHODS In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. RESULTS App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, <i>P</i>=.02), indicating better colonoscopy preps. In total, 75% (15/20) of app users and 41% (9/22) of written instruction users had preps categorized as “excellent” on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50%], written instruction users 8/22 [36%]; <i>P</i>=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; <i>P</i>=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; <i>P</i>=.56). CONCLUSIONS Smartphone app use was associated with an increased number of colonoscopy preps classified as “excellent” on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure.

Elevated Levels of IL-6 and IL-8 Are Associated with An Increased Risk of Venous Thromboembolism – a Case Control Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2975-2975
Author(s):  
Marinez F Matos ◽  
Dayse M Lourenço ◽  
Cristina M Orikaza ◽  
Maria A E Noguti ◽  
Vânia M Morelli
Keyword(s):  
Venous Thromboembolism ◽  
Prospective Studies ◽  
Plasma Levels ◽  
Conflicts Of Interest ◽  
Limit Of Detection ◽  
Case Control ◽  
Control Group ◽  
Case Control Studies ◽  
Increased Risk ◽  
The Impact

Abstract Abstract 2975 Poster Board II-953 Background: high levels of some cytokines have been associated with an increased risk of venous thromboembolism (VTE) in some case-control studies, but not in prospective studies. However, data regarding the impact of cytokines levels on the risk of VTE are still limited. The aim of this study was to investigate the association between the risk of VTE and plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-αa and monocyte chemotactic protein (MCP)-1. Materials and Methods: we studied 122 patients (96 women, 79%), with a first objectively confirmed episode of VTE and with a median age of 39.5 years (range: 21-60). Exclusion criteria were malignancy, autoimmune diseases, antiphospholipid syndrome, chronic renal or liver disease and arterial thrombosis. Patients were seen at least 1 month after the discontinuation of the anticoagulant treatment and > 7 months after the event of VTE. Control group was comprised of 131 healthy subjects (105 women, 80%), with median age of 38 years (range: 18-66), recruited via the patients from the same geographic region and ethnic background. Controls were matched for age and sex. Plasma levels of cytokines were measured by commercial ELISA and a highly sensitive assay was used to measure IL-1β, IL-6 and IL-10 levels. Since a high percentage of samples of IL-1β (73%), IL-10 (62%) and TNF-αa (97%) was below the lower limit of detection (LLD) of the assay, levels of these cytokines were categorized as detectable (> LLD) and not detectable (< LLD). Elevated levels of IL-6 (> 2.15pg/mL), IL-8 (> 10.11pg/mL) and MCP-1 (> 84.11pg/mL) were defined by plasma concentration of these cytokines exceeding the 90th percentile of the distribution of the control population. Results: elevated levels of IL-6 were detected in 27% of the patients with VTE in comparison with 10% (by definition) of the controls [odds ratios (OR) = 3.4, 95% Confidence Interval (CI) 1.6 - 7.6]. Elevated levels of IL-8 were detected in 21% of the patients in comparison with 10% of the controls (OR = 2.5, 95%CI 1.1 - 5.6). The risk remained significant for IL-6 (OR = 2.8, 95%CI 1.2 - 6.5) and IL-8 (OR = 2.6, 95%CI 1.1 - 6.7) after adjustment for putative confounders (sex, age, body mass index, smoking and high levels of homocysteine and C-reactive protein). On the other hand, we found no significant association between VTE and elevated levels of MCP-1 (OR = 0.8, 95%CI 0.3 - 1.9) as well as detectable levels of IL-1β (OR = 0.9, 95%CI 0.5-1.6), IL-10 (OR = 1.3, 95%CI 0.8 - 2.2) and TNF-αa (OR = 6.7, 95%CI 0.8 - 56.7). In our study, patients were included at different time intervals after the VTE episode [median: 36 months (range: 7-87)]. No correlation was found between the time since the event of VTE and levels of IL-6 (rs = 0.06, P = 0.54) and IL-8 (rs= 0.07; P = 0.48). Conclusion: this study shows a significant impact of elevated levels of IL-6 and IL-8 on the risk of VTE in a relatively young population of patients. Interestingly, no association was found between the time since the event and the level of these cytokines. Taking into account the importance of the relationship between inflammation and VTE, more epidemiological data including prospective studies are required to elucidate the role of inflammation on the risk of VTE. This study was supported by FAPESP (2005/56799-0). Disclosures: No relevant conflicts of interest to declare.

scholarly journals SMOOTHING THE MOVE FROM POST-ACUTE TO HOME CARE FOR OLDER CARDIAC PATIENTS: A SOCIAL WORK TRANSITIONS INITIATIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S959-S959
Author(s):  
Orah R Burack ◽  
Jessica Auerbach-Burgoon ◽  
Sandra Mundy ◽  
Verena R Cimarolli
Keyword(s):  
Social Work ◽  
Cardiac Patients ◽  
Control Group ◽  
Phone Calls ◽  
Work Transitions ◽  
Difficult Time ◽  
Initial Program ◽  
Cardiac Heart Failure ◽  
The Impact

Abstract Transitioning across medical settings (e.g. from hospital to post-acute (PA) or PA to homecare (HC)) is a difficult time with numerous challenges, as critical information passes across sites, new systems are quickly established, and caretakers change. Older cardiac heart failure (CHF) patients, often with comorbidities and having fewer social supports, are especially vulnerable to rehospitalizations at that time. This study examines the impact of a Social Work Transitions (SWT) intervention, designed to ease older cardiac patients’ transition from a PA to HC setting, on rehospitalization rates. The SWT model for CHF patients was developed in a large healthcare system with a continuum of services for older adults including PA and HC. Once a patient enters PA from the hospital a transitions social worker (SW) remains the patient’s primary support and contact through PA discharge and the transition to HC. In HC, that same SW ensures needed services occur, conducts home visits, and provides additional follow-up via phone calls. Study 1: compared HC rehospitalization rates of CHF patients receiving SWT (N=28) with those not receiving SWT (N=26). This natural control group arose during the initial program months, as SW turnover occurred and some CHF patients were not accompanied by a transitions SW. SWT patients had half the rehospitalizations (25%) as controls (54%). Study 2 tracked 30 day rehospitalizations rates for the first 17 study months (N=257). Program rehospitalization rates (16.7%) were below the CMS benchmark (21%). These findings support using the SWT program to prevent unnecessary rehospitalizations in CHF patient.

Information and Communication Technology and Cultural Change

2012 ◽  
Vol 43 (4) ◽  
pp. 222-231 ◽  
Author(s):  
Nina Hansen ◽  
Tom Postmes ◽  
Nikita van der Vinne ◽  
Wendy van Thiel
Keyword(s):  
Cultural Values ◽  
Information And Communication Technology ◽  
Communication Technology ◽  
Cultural Change ◽  
Control Group ◽  
Self Construal ◽  
Information And Communication ◽  
The Impact ◽  
Ict For Development ◽  
Practical Implications

This paper studies whether and how information and communication technology (ICT) changes self-construal and cultural values in a developing country. Ethiopian children were given laptops in the context of an ICT for development scheme. We compared children who used laptops (n = 69) with a control group without laptops (n = 76) and a second control group of children whose laptop had broken down (n = 24). Results confirmed that after 1 year of laptop usage, the children’s self-concept had become more independent and children endorsed individualist values more strongly. Interestingly, the impact of laptop usage on cultural values was mediated by self-construal (moderated mediation). Importantly, modernization did not “crowd out” traditional culture: ICT usage was not associated with a reduction in traditional expressions (interdependent self-construal, collectivist values). Theoretical and practical implications are discussed.

A Newspaper’s Effect on the Strength of Automatic Associations in Memory

2012 ◽  
Vol 24 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Florian Arendt
Keyword(s):  
Treatment Group ◽  
Term Effect ◽  
Control Group ◽  
Implicit Measure ◽  
Short Term ◽  
Short Term Treatment ◽  
Short Term Effect ◽  
Automatic Associations ◽  
Foreign Nationality ◽  
The Impact

A test was done to see if reading a newspaper which consistently overrepresents foreigners as criminals strengthens the automatic association between foreign country and criminal in memory (i.e., implicit cultivation). Further, an investigation was done to find out if reading articles from the same newspaper produces a short-term effect on the same measure and if (1) emotionalization of the newspaper texts, (2) emotional reactions of the reader (indicated by arousal), and (3) attributed text credibility moderate the short-term treatment effect. Eighty-five participants were assigned to one of three experimental conditions. Participants in the control group received short factual crime texts, where the nationality of the offender was not mentioned. Participants in the factual treatment group received the same texts, but the foreign nationality was mentioned. Participants in the emotionalized treatment group received emotionalized articles (i.e., texts which are high in vividness and frequency) covering the same crimes, with the foreign nationality mentioned. Supporting empirical evidence for implicit cultivation and a short-term effect was found. However, only emotionalized articles produced a short-term effect on the strength of the automatic association, indicating that newspaper texts must have a minimum of stimulus intensity to overcome an effect threshold. There were no moderating effects of arousal or credibility pertaining to the impact on the implicit measure. However, credibility moderated the short-term effect on a first-order judgment (i.e., estimated frequency of foreigners of all criminals). This indicates that a newspaper’s effect on the strength of automatic associations is relatively independent from processes of propositional reasoning.

Impact of an educative program on dialysis patients’ knowledge and mental health: controlled before and after program

2018 ◽  
Vol 10 (2) ◽  
pp. 20204
Author(s):  
Laetitia Idier ◽  
Aurélie Untas ◽  
Nicole Rascle ◽  
Michèle Koleck ◽  
Maider Aguirrezabal ◽  
...  
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Vascular Access ◽  
Educational Program ◽  
Psychological State ◽  
Control Group ◽  
Dialysis Patients ◽  
Emotional Change ◽  
The Impact ◽  
Experimental Group

Introduction:Psychological impact of Therapeutic Patient Education (TPE) for dialysis patients is rarely evaluated since the focus of many studies is on medical variables (i.e., adherence).Objectives:The aims of this study were: 1) to estimate the impact of a TPE program on knowledge, depression and anxiety, 2) to examine change in knowledge as a mediator of the effects of a TPE program on mental health.Method:This study was conducted in three hemodialysis units and comprised two groups: an experimental group with education and a control group with routine care. The program was based of 5 educative sessions. Knowledge, depressive and anxious symptoms were assessed with self-reported outcomes measured before and 3 months after the program.Results:The sample comprised 125 patients. Knowledge about vascular access and nutrition (p < 0.01) and depressive symptoms increased in the experimental group (p < 0.01). Analysis of mediation showed that changes in knowledge about vascular access were a significant mediator of the effects of the program on depressive symptoms (F = 4.90;p = 0.01).Discussion:Knowledge acquired during an educational program could lead to an emotional change. Improving knowledge often leads to an awareness of the risks that can modify the psychological state of patients by reminding them of their vulnerability. This study shows that it is required to be attentive to the way of transmitting knowledge. It’s necessary adapting this transmission to the needs of patients and promoting the acquisition of psychosocial competence too.Conclusion:This study shows that knowledge acquired during an educational program can lead to an emotional change in the short term. A long-term follow-up of the population should be interesting to observe these emotional effects.

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