scholarly journals AM Versus PM Postoperative Administration of Warfarin With a Mechanical Mitral Valve

2020 ◽  
pp. 875512252097361
Author(s):  
Justin R. Harris ◽  
Rachel Hatch ◽  
Prashanth Vallabhajosyula ◽  
Yancy Lo ◽  
Danielle Mowery ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Large Scale ◽  
Intervention Group ◽  
Mechanical Valve ◽  
International Normalized Ratio ◽  
Post Intervention ◽  
Thrombotic Complications ◽  
Administration Timing ◽  
Evening Administration

Background: Currently, there are no guidelines regarding the optimal daily timing of inpatient warfarin administration. Objective: The purpose of this study was to determine whether dosing warfarin in the morning will have a significant impact on therapeutic international normalized ratio (INR) achievement compared with evening administration in mechanical mitral valve patients initiated on warfarin following cardiac surgery. Methods: This was a single-center, pre- and post-retrospective cohort conducted between 2014 and 2018. One-hundred fifty-four adult patients who underwent a mechanical mitral valve replacement or alternative cardiac surgery with a history of a mechanical mitral valve were enrolled. The primary outcome was achievement of therapeutic INR at any time point after initiation of warfarin. Pre-intervention administration timing was 6 pm and post-intervention timing was 10 am. Results: Baseline characteristics including age, sex, and race were similar between the 2 groups ( P = NS for each characteristic). Therapeutic INR achievement was significantly improved at all time points following 10 am warfarin administration compared with 6 pm (hazard ratio = 1.69; P = .005). Mean time-to-therapeutic INR was 7.37 days in the post-intervention group and 8.39 days in the pre-intervention group ( P = .073). There were no significant differences in INR >4, bleeding, or thrombotic complications between groups. Conclusion and Relevance: This retrospective analysis suggests that there may be a postoperative benefit in therapeutic INR achievement in mechanical valve patients when dosing warfarin in the morning compared with evening administration. Large-scale studies should be conducted to further elucidate the potential benefit across more heterogeneous populations.

scholarly journals Mobile Technology Integrated into a Large-Scale Nutrition Program Enables Age-Appropriate Home Visits and Counseling for Mothers of Infants in India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 886-886
Author(s):  
Sumeet Patil ◽  
Sneha Nimmagadda ◽  
Lakshmi Gopalakrishnan ◽  
Rasmi Avula ◽  
Sumati Bajaj ◽  
...  
Keyword(s):  
Large Scale ◽  
Program Effectiveness ◽  
Health Workers ◽  
Life Stage ◽  
Intervention Group ◽  
Home Visits ◽  
Small Scale ◽  
Post Intervention ◽  
Mhealth Intervention ◽  
Age Appropriate

Abstract Objectives An mHealth job aid and real time monitoring tool currently targets over 1 million community health workers in India (Anganwadi workers – AWWs). Previous studies have shown that mHealth interventions can be effective at a small scale. In this study, we evaluate whether this at-scale mHealth intervention improved the quantity and quality of AWW home visits and counseling. We also examined whether these improvements led to better infant and young child feeding (IYCF) practices among beneficiaries. Methods The mHealth intervention (Common Application Software – CAS) is currently being used by 581,282 AWWs across India. We conducted a village-matched, quasi-experimental design to examine program effectiveness across 428 villages in Madhya Pradesh (MP) and Bihar (BH). Repeated cross-sectional surveys were completed 17–24 months apart with AWWs (n = 1344) and mothers of children < 12 m (n = 6635). We compared post-intervention outcomes between matched groups, controlling for average baseline outcome levels and other covariates to correct for imbalances and improve precision. Program effects were assessed separately within each state. Results In both states, mothers in the intervention group were more likely to receive adequate number of home visits (MP: control = 42%; ß = 9.1%; P < 0.05; BH: control = 24%; ß = 7.7%; P < 0.05). A larger proportion of mothers in the intervention group could recall at least half the life-stage appropriate counseling messages (MP: control = 28.1%; ß = 11.8%. BH: control = 9.5%; ß = 7.7%). However, no improvements in IYCF practices were associated with the intervention. Conclusions mHealth interventions like CAS can support gains in immediate term service delivery outcomes by enabling more age-appropriate home-visits and counseling. However, impacts on nutrition and health behaviors will require a longer-term evaluation and parallel efforts to improve a range of other outcomes, including structural poverty, gender norms, and larger socio-economic and political factors. Funding Sources The Bill and Melinda Gates Foundation.

scholarly journals Development and acceptability of a peer-paired, cross-cultural and cross-generational storytelling HPV intervention for Korean American college women

2019 ◽  
Vol 34 (5) ◽  
pp. 483-494 ◽  
Author(s):  
Minjin Kim ◽  
Haeok Lee ◽  
Peter Kiang ◽  
Jeroan Allison
Keyword(s):  
Cervical Cancer ◽  
College Women ◽  
Large Scale ◽  
Comparison Group ◽  
Hpv Vaccination ◽  
Intervention Group ◽  
Korean American ◽  
Cross Cultural ◽  
Post Intervention ◽  
The Impact

Abstract Although Korean American women have a higher risk of developing cervical cancer, currently there are limited culturally relevant intervention strategies for improving primary prevention of cervical cancer by promoting HPV vaccination in this population. This study reports the development of a cross-cultural, cross-generational storytelling HPV intervention using a peer-paired method, in which two storytellers interactively share their stories, as a particular innovation that might resonate with Korean American young women. The acceptability of the intervention was assessed by self-reported satisfaction and endorsement with the intervention in a pilot randomized control trial (RCT). We compared participants’ responses to the intervention by their generation and cultural identity. One hundred and four Korean college women between the ages of 18–26 were recruited from the Northeastern US Participants randomized to the intervention group received a storytelling video (n = 54); the comparison group received written information (n = 50). The acceptability of the intervention was measured immediately post-intervention. The intervention group had significantly greater satisfaction than the comparison group (P < 0.05). Participants reported greater endorsement for videos that reflected their cultural and generational experiences. Future study is needed to examine the impact of such interventions on objective follow-up on HPV vaccination in a large-scale RCT.

scholarly journals Artificial Intelligence based personalized diet: A pilot clinical study for IBS

2021 ◽  
Author(s):  
Tarkan Karakan ◽  
Aycan Gundogdu ◽  
Hakan Alagözlü ◽  
Nergis Ekmen ◽  
Seckin Ozgul ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Large Scale ◽  
Intervention Group ◽  
Gastrointestinal Symptoms ◽  
Symptom Improvement ◽  
Control Group ◽  
Post Intervention ◽  
Fecal Microbiome ◽  
Microbiome Composition ◽  
Symptom Severity Scale

AbstractBackground and aimsCertain diets often used to manage functional gastrointestinal symptoms in patients with irritable bowel syndrome (IBS). Personalized diet-induced microbiome modulation is being preferred method for symptom improvement in IBS. Although personalized nutritional therapies targeting gut microbiota using artificial intelligence (AI) promises a great potential, this approach has not been studied in patients with IBS. Therefore, in this study we investigated the efficacy of AI-based personalized microbiome diet in patients with IBS-Mix (M).MethodsThis study was designed as a pilot, open-labelled study. We enrolled consecutive IBS-M patients (n=25, 19 females, 46.06 ± 13.11 years) according to Rome IV criteria. Fecal samples were obtained from all patients twice (pre- and post-intervention) and high-througput 16S rRNA sequencing was performed. Patients were divided into two groups based on age, gender and microbiome matched. Six weeks of AI-based microbiome diet (n=14) for group 1 and standard IBS diet (Control group, n=11) for group 2 were followed. AI-based diet was designed based on optimizing a personalized nutritional strategy by an algorithm regarding individual gut microbiome features. An algorithm assessing an IBS index score using microbiome composition attempted to design the optimized diets based on modulating microbiome towards the healthy scores. Baseline and post-intervention IBS-SSS (symptom severity scale) scores and fecal microbiome analyses were compared.ResultsThe IBS-SSS evaluation for both pre- and post-intervention exhibited significant improvement (p<0.02 and p<0.001 for the control and intervention groups, respectively). While the IBS-SSS evaluation changed to moderate from severe in 82% (14 out of 17) of the intervention group, no such change was observed in the control group. After 6-weeks of intervention, a major shift in microbiota profiles in terms of alfa- or beta-diversity was not observed in both groups. A trend of decrease in Ruminococcaceae family for the intervention group was observed (p=0.17). A statistically significant increase in Faecalibacterium genus was observed in the intervention group (p = 0.04). Bacteroides and putatively probiotic genus Propionibacterium were increased in the intervention group, however Prevotella was increased in the control group. The change (delta) values in IBS-SSS scores (before-after) intervention and control groups are significantly higher in the intervention group.ConclusionAI-based personalized microbiome modulation through diet significantly improves IBS-related symptoms in patients with IBS-M. Further large scale, randomized placebo-controlled trials with long-term follow-up (durability) are needed.

scholarly journals Health education through mass media announcements by loudspeakers about malaria care: prevention and practice among people living in a malaria endemic area of northern Myanmar

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Pyae Linn Aung ◽  
Tepanata Pumpaibool ◽  
Than Naing Soe ◽  
Jessica Burgess ◽  
Lynette J. Menezes ◽  
...  
Keyword(s):  
Intervention Group ◽  
Malaria Prevention ◽  
Care Seeking ◽  
Endemic Region ◽  
Post Intervention ◽  
Chi Square ◽  
Transmission Season ◽  
Baseline Knowledge ◽  
Peak Transmission

Abstract Background Interventions to raise community awareness about malaria prevention and treatment have used various approaches with little evidence on their efficacy. This study aimed to determine the effectiveness of loudspeaker announcements regarding malaria care and prevention practices among people living in the malaria endemic villages of Banmauk Township, Sagaing Region, Myanmar. Methods Four villages among the most malaria-burdened areas were randomly selected: two villages were assigned as the intervention group, and two as the control. Prior to the peak transmission season of malaria in June 2018, a baseline questionnaire was administered to 270 participants from randomly selected households in the control and intervention villages. The loudspeaker announcements broadcasted health messages on malaria care and prevention practices regularly at 7:00 pm every other day. The same questionnaire was administered at 6-month post intervention to both groups. Descriptive statistics, Chi-square, and the t-test were utilized to assess differences between and within groups. Results Participants across the control and intervention groups showed similar socio-economic characteristics; the baseline knowledge, attitude and practice mean scores were not significantly different between the groups. Six months after the intervention, improvements in scores were observed at p-value < 0.001 in both groups, however; the increase was greater among the intervention group. The declining trend of malaria was also noticed during the study period. In addition, more than 75% of people expressed positive opinions of the intervention. Conclusions The loudspeaker intervention was found to be feasible and effective, as shown by the significant improvement in scores related to prevention and care-seeking practices for malaria as well as reduced malaria morbidity. Expanding the intervention to a larger population in this endemic region and evaluating its long-term effectiveness are essential in addition to replicating this in other low-resource malaria endemic regions.

An Internet-based health gateway device for interactive communication and automatic data uploading: Clinical efficacy for type 2 diabetes in a multi-centre trial

2016 ◽  
Vol 23 (6) ◽  
pp. 595-604 ◽  
Author(s):  
Jae Hyoung Cho ◽  
Hun-Sung Kim ◽  
Seung Hyun Yoo ◽  
Chang Hee Jung ◽  
Woo Je Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Healthcare System ◽  
Glucose Control ◽  
Large Scale ◽  
Diabetes Management ◽  
Intervention Group ◽  
Diabetes Control ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Automatic Data

Introduction The aim of this study was to improve the quality of diabetes control and evaluate the efficacy of an Internet-based integrated healthcare system for diabetes management and safety. Methods We conducted a large-scale, multi-centre, randomized clinical trial involving 484 patients. Patients in the intervention group ( n = 244) were treated with the Internet-based system for six months, while the control group ( n = 240) received the usual outpatient management over the same period. HbA1c, blood chemistries, anthropometric parameters, and adverse events were assessed at the beginning of the study, after three months, and the end of the study. Results There were no initial significant differences between the groups with respect to demographics and clinical parameters. Upon six-month follow-up, HbA1c levels were significantly decreased from 7.86 ± 0.69% to 7.55 ± 0.86% within the intervention group ( p < 0.001) compared to 7.81 ± 0.66% to 7.70 ± 0.88% within the control group. Postprandial glucose reduction was predominant. A subgroup with baseline HbA1c higher than 8% and good compliance achieved a reduction of HbA1c by 0.8 ± 1.05%. Glucose control and waist circumference reduction were more effective in females and subjects older than 40 years of age. There were no adverse events associated with the intervention. Discussion This e-healthcare system was effective for glucose control and body composition improvement without associated adverse events in a multi-centre trial. This system may be effective in improving diabetes control in the general population.

scholarly journals Effect of “Spatially Separated Speech in Noise Training” on speech perception in noise in children with bimodal fitting

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Younes Lotfi ◽  
Mahdieh Hasanalifard ◽  
Abdollah Moossavi ◽  
Enayatollah Bakhshi ◽  
Mohammad Ajalloueyan
Keyword(s):  
Speech Perception ◽  
Intervention Group ◽  
Auditory Training ◽  
Control Group ◽  
Interventional Study ◽  
Post Intervention ◽  
Speech Perception In Noise ◽  
Speech In Noise ◽  
Significant Difference ◽  
Recognition Ability

Abstract Background The objective of this study was to evaluate the effect of “Spatially separated speech in noise” auditory training on the ability of speech perception in noise among bimodal fitting users. The assumption was that the rehabilitation can enhance spatial hearing and hence speech in noise perception. This study was an interventional study, with a pre/post-design. Speech recognition ability was assessed with the specific tests. After performing the rehabilitation stages in the intervention group, the speech tests were again implemented, and by comparing the pre- and post-intervention data, the effect of auditory training on the speech abilities was assessed. Twenty-four children of 8–12 years who had undergone cochlear implantation and continuously used bimodal fitting were investigated in two groups of control and intervention. Results The results showed a significant difference between the groups in different speech tests after the intervention, which indicated that the intervention group have improved more than the control group. Conclusion It can be concluded that “Spatially separated speech in noise” auditory training can improve the speech perception in noise in bimodal fitting users. In general, this rehabilitation method is useful for enhancing the speech in noise perception ability.

scholarly journals Effects and Responsiveness of a Multicomponent Intervention on Body Composition, Physical Fitness and Leptin in Overweight/Obese Adolescents

2021 ◽  
Vol 18 (14) ◽  
pp. 7267
Author(s):  
Leticia Borfe ◽  
Caroline Brand ◽  
Letícia Schneiders ◽  
Jorge Mota ◽  
Claudia Cavaglieri ◽  
...  
Keyword(s):  
Body Composition ◽  
Physical Fitness ◽  
Intervention Group ◽  
Interleukin 10 ◽  
Control Group ◽  
Post Intervention ◽  
Necrosis Factor Alpha ◽  
Obese Adolescents ◽  
Quasi Experimental ◽  
Multicomponent Program

Physical exercise reduces the biochemical markers of obesity, but the effects of multicomponent interventions on these markers should be explored. The present study aimed to elucidate how overweight/obese adolescents respond to a multicomponent program approach on body composition, physical fitness, and inflammatory markers, using a quasi-experimental study with 33 overweight/obesity adolescents (control group (CG) = 16; intervention group (IG) = 17). The intervention consisted of 24 weeks with physical exercises and nutritional and psychological guidance. Both groups were evaluated at the pre/post-intervention moments on body mass index (BMI); body fat (%Fat); waist circumference (WC); waist/hip ratio (WHR); waist-to-height ratio (WHtR), cardiorespiratory fitness (CRF); abdominal strength, flexibility; leptin; interleukin 6; interleukin 10; and tumor necrosis factor-alpha. Mixed-analysis of variance and generalized estimation equations were used for statistical analysis. There was an interaction effect between groups and time on %Fat (p = 0.002), WC (p = 0.023), WHR (p < 0.001), WHtR (p = 0.035), CRF (p = 0.050), and leptin (p = 0.026). Adolescents were classified as 82.4% responders for %Fat, 70.6% for WC, 88.2% for WHR, and 70.6% for CRF. Further, there was an association between changes in %Fat (p = 0.033), WC (p = 0.032), and WHR (p = 0.033) between responders and non-responders with CRF in the IG. There was a positive effect on body composition, physical fitness, and leptin. In addition, reductions in body composition parameters were explained by CRF improvements.

scholarly journals Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Terézia B. Andrási ◽  
Nunijiati Abudureheman ◽  
Alannah Glück ◽  
Maximilian Vondran ◽  
Gerhard Dinges ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Surgical Instruments ◽  
Tricuspid Valve Repair ◽  
Long Term Outcome ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
Neurosurgical Intervention

Abstract Background The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case presentation A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. Conclusion The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

scholarly journals 87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Noor F Zaidan ◽  
Rachel S Britt ◽  
David Reynoso ◽  
R Scott Ferren
Keyword(s):  
Staphylococcus Aureus ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Kidney Injury ◽  
Post Intervention ◽  
Gram Positive ◽  
Stewardship Program ◽  
Screening Protocol ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections. Methods Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020. Results Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted. Conclusion A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted. Disclosures All Authors: No reported disclosures

scholarly journals A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

AbstractBackground Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

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