Refining Blood Products Utilization: Every One (unit) Matters. Post-Intervention Study

INTRODUCTION: Transfusion of red blood cells (RBCs) is a balance between providing benefits for patients while avoiding risks of transfusion. Meta-analyses of randomized controlled trials (RCT) comparing restricted versus liberal blood transfusion showed that there was no significant difference in terms of morbidity, mortality, or risk of myocardial infarction. In fact, the restrictive strategy had a significantly lower risk of all-cause mortality in patients with gastrointestinal bleeding. It also resulted in a significantly lower number of transfused units and a lower number of patients needing a transfusion. Examining the extent of adherence to the American Association of Blood Banks (AABB) transfusion guidelines in our VA medical center showed that the average transfused units were 1.4 units per person. The Average pre-transfusion hemoglobin (Hgb) was 7.6. 54% received 2 units, whereas 46% received 1 unit. AIM OF THE WORK: To improve the blood transfusion practice in our VA medical center to better comply with the (AABB) transfusion guidelines and to establish a culture of change to improve patient safety, minimize risks of transfusion reaction and reduce the cost. METHODOLOGY: This is a prospective analysis of transfused patients in the period of November 2019 to April 2020 (n=228) as a continuation of the prior retrospective analysis of randomly selected patients in 2018 (n=162). The data was retrieved from an electronic medical record database, which included patient gender, age, co-morbidities, mean baseline Hgb, pre- and post-transfusion Hgb, hemodynamic status, ordering division, and the number of units transfused. INTERVENTIONS We implemented a two-tier auditing system, based on a low and high priority, which reflects the timeline to address non-compliant transfusion orders. Low priority orders were evaluated during the periodic meeting of the transfusion committee, and high priority orders were addressed within a few hours of the transfusion order. All transfusion orders of Hgb > 7-8 g/dL were flagged with low priority, whereas those with Hgb > 8 g/dL and/or with orders exceeding one unit were flagged with high priority. The appropriate approval was obtained through the institutional review board (IRB), patients' consents for enrollment, and anonymity was maintained all through the study. RESULTS: The total number of transfused PRBC units was 386 units with a mean of 1.6 units per patient compared to 1.7 units in the pre-intervention group (p=0.056). The average Hgb before transfusion was 7.7 mg/dL compared to 7.5 mg/dL in the pre- versus the post-intervention group (p=0.659). Comparing the pre-transfusion Hgb values in both groups per ordering division showed that the average Hgb values were lower after the intervention among all divisions except for the hematology/oncology department. This difference was statistically significant in the Intensive Care Unit (ICU). In terms of the number of transfused units, overall, there was a decrease in the number of transfused units, however, this was not statistically significant.(table 1) The department with the highest number of transfused units was internal medicine. DISCUSSION: Our study showed that the application of an auditing system within the electronic medical system resulted in significant improvement in the transfusion practice in the ICU department. The lack of significant effects among other departments can be attributed to the lower number of cases in the pre- versus post-intervention cohorts, e.g. 22 versus 50 in the Hematology/Oncology department and 6 versus 26 in the Emergency Department. Besides, it was difficult to gauge the reasoning for blood transfusion among the different departments whether it was for objectively significant blood loss despite the stable hemodynamics, or due to symptomatic anemia. The overall acceptance of the new system should be further investigated through a qualitative study e.g. individual interviewing or group discussions to explore reasons for possible resistance to change. CONCLUSION: Changing the transfusion order can help in improving the transfusion practice in healthcare facilities. However, this strategy alone may not be effective, and further investigations into the root causes of the non-significant change in some departments are needed. Enforcing the electronic auditing system along with staff development workshops may result in better outcomes. Disclosures No relevant conflicts of interest to declare.

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Massive Transfusion Protocols: Indications, Ratios and Mortality in the Non-Trauma Setting

Blood ◽

10.1182/blood.v126.23.2348.2348 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2348-2348 ◽

Cited By ~ 2

Author(s):

Robert A. DeSimone ◽

Cheryl A. Goss ◽

Yen-Michael S. Hsu ◽

Thorsten Haas ◽

Melissa M. Cushing

Keyword(s):

Blood Product ◽

Massive Transfusion ◽

Conflicts Of Interest ◽

Medical Center ◽

Binary Logistic Regression ◽

Blood Bank ◽

P Value ◽

Trauma Patients ◽

Number Of Patients ◽

Significant Difference

Abstract Background: Many institutions have implemented massive transfusion protocols (MTPs) to prevent hemodilution and to restore normal coagulation function, with the ultimate goal of controlling hemorrhage and reducing complications. Our institution issues two different MTPs: trauma (T-) and non-trauma (NT-). T-MTPs have a 1:1 ratio for red blood cell (RBC):plasma issued by the blood bank, whereas NT-MTPs have a 1.8:1 ratio. Appropriate blood product ratios, indications and patient outcomes in the NT-MTP setting are not well studied. To determine how various MTP parameters impact 24-hour patient mortality, we retrospectively reviewed MTP activations at our large academic urban medical center. Methods: All activated MTPs over a 3-year period (2012-2014) were reviewed. Data was collected from blood bank quality assurance and inpatient electronic medical records. NT-MTPs were sub-classified into indication by type of hemorrhage. All statistical analyses (binary logistic regression, Kruskal-Wallis) were performed using STATA version 11. A p value of <0.05 was considered significant. Results: From 2012-2014, there were 177 MTP activations for 167 patients, of which 98 were male (59%) and 69 were female (41%). The average age of all patients was 56 years, with a range of 7 months to 95 years. Trauma patients (mean age 40 years) tended to be younger than non-trauma patients (mean age 60 years). Refer to Table 1 for types of hemorrhage and ratios of blood products transfused. Thirty-eight patients (22.8%) died within 24 hours of MTP activation, including 10 (30.3%) of the trauma patients and 28 (21.7%) of the non-trauma patients (Figure 1). Mortality did not vary significantly by type of hemorrhage or by ratio of RBC:plasma transfused, including patients receiving no plasma. For each additional RBC unit transfused, patients had a higher chance of dying (odds ratio [OR] 1.17; p=0.002, confidence interval 1.1-1.3) within 24 hours, after controlling for number of platelet, plasma, and cryoprecipitate units received. The overall median RBC:plasma ratio transfused was 1.7 (interquartile range [IQR] 1.3-2); T-MTPs had a median ratio of 1.4 (IQR 1.1-1.9) and NT-MTPs had a median ratio of 1.7 (IQR 1.3-2.1). There was no significant difference in RBC:plasma ratios clinicians transfused for different types of hemorrhage, despite the blood bank issuing different ratios to the clinicians for T-MTPs and NT-MTPs. The total number of RBCs, platelet units, and plasma units transfused did not differ by type of hemorrhage. In all MTPs, transfusion of platelets did not have a significant impact on 24-hour survival. Conclusions: We found that only the number of RBC units transfused had a significant association (OR 1.17) with 24-hour mortality during an MTP. The RBC:plasma ratio, number of platelets or plasma, and use of platelets during an MTP did not affect 24-hour mortality. The number of RBC units transfused most likely reflects the clinician's assessment of the severity of the situation, and does not imply that the RBCs affected the 24-hour mortality. We found the ratio of products issued during an MTP was not what was actually transfused to patients, indicating that clinicians were not transfusing according to protocol. Specifically, for NT-MTPs overall, the RBC:plasma ratio transfused was lower than what the blood bank issued, indicating clinicians are choosing to infuse more plasma despite a lack of evidence in the non-trauma setting. Prospective randomized trials comparing different RBC:plasma:platelet ratios in NT-MTPs are warranted. Table 1. Blood Product Ratios Transfused by Type of Hemorrhage Type of Hemorrhage Number of Patients (%) RBC:Plasma - Median (IQR) RBC:Platelets - Median (IQR) Overall 167 (100%) 1.7 (1.3-2) 5 (4-7) Trauma 33 (20%) 1.4 (1.1-1.9) 5.5 (3.7-8.4) Postoperative 50 (30%) 1.6 (1.3-1.8) 5 (3.5-6) Gastrointestinal 29 (17%) 2 (1.7-2) 5 (4-7) Intraoperative 20 (12%) 1.6 (1.3-2.7) 6.2 (3.3-7.5) Abdominal 11 (7%) 2 (1.3-3.3) 6 (4-7) Vascular 9 (5%) 1.3 (1-2) 5 (2-5) Obstetrical 8 (5%) 2.2 (2-2.3) 5 (4-7) Central Nervous System 4 (2%) 1.8 (1.2-4) 4.2 (4-4.3) Pulmonary 2 (1%) 2 2 Superficial Soft Tissue 1 (0.5%) 1 N/A Figure 1. 24-Hour Mortality by Type of Hemorrhage Figure 1. 24-Hour Mortality by Type of Hemorrhage Disclosures No relevant conflicts of interest to declare.

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

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00130-9 ◽

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.

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Perceptions of caregivers on immunization in Ntungamo district, Uganda

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214559 ◽

2021 ◽

Vol 8 (12) ◽

pp. 5729

Author(s):

Byamukama Topher ◽

Keraka M. Margaret ◽

Gitonga Eliphas

Keyword(s):

Risk Factor ◽

Intervention Group ◽

Cost Effective ◽

Systematic Sampling ◽

Control Group ◽

Post Intervention ◽

Mortality And Morbidity ◽

Significant Difference ◽

Quasi Experimental ◽

And Control

Background: Immunization is one of the most cost-effective public health interventions to reduce child mortality and morbidity associated with infectious diseases. The objective of this study was to determine the perceptions of caregivers on immunization in Ntungamo district.Methods: Quasi-experimental study was used with health centres assigned to intervention and control groups. Purposive sampling was used to select the two counties where the study was done. Proportional sampling was done to get study samples from each health facility, while systematic sampling was done to get study participants. A total of 787 children from twelve health facilities provided the study sample. A post intervention evaluation was conducted to determine the effect of these interventions. Association of variables was tested using Mann Whitney U-test and Chi-square.Results: On benefits, most caregivers in the intervention group (85.3%) and in the control group (54.3%) regarded immunization as very highly and moderately beneficial to their children respectively. On risks, most caregivers in the intervention group (85.5%) and control group (43.1%) regarded the risk factor associated with immunization as very low and moderate respectively. From hypothesis testing, there was a significant difference on the perceived benefits and risks of immunization between the intervention and control group.Conclusions: Most caregivers in the intervention and control group regarded immunization as very highly beneficial and moderately to their children respectively. Most of the caregivers in the intervention and control group regarded the risk factor associated with immunization as very low and moderate respectively.

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Abstract 13198: Impact of Targeted Resident Education on Perceptions of Communication and Participation in Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.13198 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Saahil Jumkhawala ◽

Maciej Tysarowski ◽

Hasan Ali ◽

Majd Hemam ◽

Anne Sutherland

Keyword(s):

Cardiac Arrest ◽

Current Knowledge ◽

Medical Center ◽

Tertiary Care ◽

Training Session ◽

Participation Rate ◽

Post Intervention ◽

Code Blue ◽

Tertiary Care Medical Center ◽

Significant Difference

Introduction: Debriefing sessions after in-hospital cardiac arrest have been demonstrated to improve teamwork and survival outcomes. Though recommended in 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, implementation remains low. Hypothesis: We postulated that a didactic training session provided to code leaders would increase rates of participation of AHA-recommended post-arrest debriefing sessions. Methods: Surveys were distributed to hospital personnel who participate in code blue/ERTs at an academic, tertiary-care medical center. Questions were graded on Likert scale to assess provider-reported perceptions of teamwork, communication, and confidence in conducting and participating in Code Blues. Participants were stratified in groups depending on whether they had previously participated in debriefing sessions. Primary outcomes were quantified using a Likert-type scale ranging from 1 to 5. Surveys were compared to surveys from prior years to assess if the intervention of a code blue didactics lecture delivered to code leaders resulted in any change in overall participation rate in the debriefing protocol. Results: Among 181 participants (61% female), 32% were residents, 54% nurses, 1.7% respiratory therapists. Self-evaluated current knowledge of ACLS protocols was significantly higher in the debriefing group (p = 0.0098), while there were no differences in perceived communication (p=0.76), and confidence in leading (p = 0.2) and participating (p = 0.2). We did not find a statistically significant difference in debriefing participation rate after our intervention (57% pre vs 58% post intervention, p=0.8), even when stratified by hospital role: critical care nurses (50% vs 71%, p=0.3), non-ICU nurses (68% vs 57%, p=0.3) and residents (67% vs 50%, p=0.2). Conclusions: Our study demonstrated that participation in post-code debriefing sessions was associated with a statistically significant increase in knowledge of cardiac arrest protocols. A code blue didactics lecture did not result in a statistically significant increase in post-arrest debriefing participation. Further study to elucidate methods to enhance adoption of this crucial, guideline recommended practice is warranted.

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Effectiveness of an Educational Intervention to Participation in Physical Activity: A quasi-experimental model-based study

10.21203/rs.2.22356/v1 ◽

2020 ◽

Author(s):

Saeideh Shahsavari ◽

Sakineh dadipoor ◽

Mohtasham Ghaffari ◽

Ali Safari-Moradabadi

Keyword(s):

Physical Activity ◽

Educational Intervention ◽

Stages Of Change ◽

Intervention Group ◽

T Test ◽

Control Group ◽

Post Intervention ◽

Chi Square ◽

Significant Difference ◽

Quasi Experimental

Abstract Background: The aim of the present study was to assess readiness to become or stay physically active according to the Stages of Change Model.Methods: The present quasi-experimental study was conducted on 100 women working in the healthcare centres of Bandar Abbas, Iran. The sampling method is clustering in type. The subjects were assigned into two groups of intervention and control. The collected data were analysed by SPSS-16 software using descriptive and inferential statistics, including independent-sample t-test, paired-sample t-test and Chi-square test.Results: Before the educational intervention, 19 subjects (0.38%) from the intervention group showed to have regular physical activity (4-5 stages). This number changed to 29 (0.58%) and 25 (0.50%) after three months and six months of intervention. A statistically significant difference was found before the intervention and 3 and 6 months afterwards (P˂.001). In the control group, no statistically significant difference was found between the pre-intervention and post-intervention (three months (P=.351) and six months (P=.687).Conclusion: The educational intervention based on the stages of behaviour change model showed to be effective in promoting the physical activity of employed women. These findings may benefit health education researchers and practitioners who tend to develop innovative theory-based interventions and strategies to increase the level of physical activity in women.

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Effect of Pressure Injury Prevention Guides Used In a Pediatric Intensive Care

Clinical Nursing Research ◽

10.1177/1054773818817696 ◽

2019 ◽

Vol 29 (4) ◽

pp. 249-255

Author(s):

Gülzade Uysal ◽

Duygu Sönmez Düzkaya ◽

Tülay Yakut ◽

Gülçin Bozkurt

Keyword(s):

Intensive Care ◽

Treatment Group ◽

Injury Prevention ◽

Intervention Group ◽

Pediatric Intensive Care ◽

Control Group ◽

Post Intervention ◽

Significant Difference ◽

Pressure Injury ◽

Pressure Injury Prevention

The aim of this study was to determine the effectiveness of a pressure injury prevention guide used in a pediatric intensive care unit (PICU) on the occurrence of pressure injuries. The design is a pre-post intervention with a control group and a prospective intervention group. Pressure injuries occurred on 9.4% of children in the nontreatment group, and in 3.6% of children in the treatment group. There was a statistically significant difference in the occurrence of pressure injuries between the nontreatment group and the treatment group ( p = .033). The average Braden Q pressure injury score was 12.20 ± 2.280 at the beginning of the intensive care hospitalization, and 13.73 ± 3.312 at discharge in the treatment group ( p < .001). The results show that the risk of pressure injuries was reduced and pressure injuries occurred later when an evidence-based pressure injury prevention guide was used.

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Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.334 ◽

2016 ◽

Vol 37 (4) ◽

pp. 448-454 ◽

Cited By ~ 15

Author(s):

Mohamed Sarg ◽

Greer E. Waldrop ◽

Mona A. Beier ◽

Emily L. Heil ◽

Kerri A. Thom ◽

...

Keyword(s):

Intensive Care ◽

Urine Culture ◽

Medical Center ◽

Academic Medical Center ◽

Intervention Group ◽

Antimicrobial Use ◽

Post Intervention ◽

Icu Patients ◽

Antimicrobial Utilization ◽

Academic Medical

OBJECTIVETo assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.DESIGNQuasi-experimental studySETTINGA 700-bed academic medical centerPATIENTSPatients admitted to any adult ICUMETHODSAggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.RESULTSStatistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.CONCLUSIONA change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

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1087. Fluoroquinolone Prophylaxis vs. No Bacterial Prophylaxis in Hospitalized Neutropenic Patients Undergoing Induction Chemotherapy for Acute Myeloid Leukemia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.951 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S386-S386

Author(s):

Carley Buchanan ◽

Derek N Bremmer ◽

Anna Koget ◽

Matthew Moffa ◽

Nathan Shively ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Induction Chemotherapy ◽

Myeloid Leukemia ◽

Intervention Group ◽

Additional Treatment ◽

Newly Diagnosed ◽

Post Intervention ◽

Number Of Patients ◽

Neutropenic Patients ◽

Acute Myeloid

Abstract Background Despite evidence to support outpatient anti-pseudomonal fluoroquinolone (FQ) prophylaxis in neutropenic patients, limited data exist to support this for inpatients undergoing induction chemotherapy for acute myeloid leukemia (AML). At our institution, we implemented an initiative to replace FQ prophylaxis with a conditional order for an anti-pseudomonal β-lactam to be given if a fever occurred. Methods A retrospective chart review was conducted to analyze the outcome differences between patients receiving FQ prophylaxis (pre-intervention) and those who had a conditional order for an anti-pseudomonal β-lactam in place of FQ prophylaxis (post-intervention). Patients were included if they were ≥18 years of age and were newly diagnosed with AML undergoing induction chemotherapy. The primary outcome was 90-day all-cause mortality. Secondary outcomes included the number of patients requiring ICU admission and rate of bacteremic episodes caused by any pathogen and from a Gram-negative rod (GNR). Additionally, ciprofloxacin susceptibility of these pathogens was analyzed. Results There were 35 and 26 patients in the pre- and post-intervention groups, respectively. Between pre- and post-intervention groups, there was no difference in 90-day mortality (20.0% vs. 15.4%; P = 0.745) or ICU admissions (25.7% vs. 23.1%, P = 1), respectively. The rate of any bacteremic episode was similar between the pre- and post-intervention groups (51.4% vs. 65.4%; P = 0.307), but more patients in the post-intervention group developed GNR bacteremia (17.1% vs. 46.2%; P = 0.023). In the patients with GNR bacteremia, the number of ciprofloxacin nonsusceptible isolates was higher in the pre-intervention group (100% vs. 30.7%; P = 0.011). Conclusion Replacing FQ prophylaxis with a conditional order for an anti-pseudomonal β-lactam for inpatients newly diagnosed with AML receiving induction chemotherapy is a feasible option to decrease FQ exposure. Though increased episodes of GNR bacteremia were observed, there was no difference in total bacteremic episodes or clinical outcomes, and the improved ciprofloxacin susceptibility patterns will allow for an additional treatment option in this extremely vulnerable patient population. Disclosures All authors: No reported disclosures.

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The Use of Tranexamic Acid in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00283 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0028

Author(s):

Laura Luick ◽

Vytas Ringus ◽

Garrett Steinmetz ◽

Spencer Falcon ◽

Shaun Tkach ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Total Ankle Arthroplasty ◽

Wound Complications ◽

P Value ◽

Ankle Arthroplasty ◽

Estimated Blood Loss ◽

Number Of Patients ◽

Significant Difference

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

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Effects of Exergaming on Preschoolers’ Executive Functions and Perceived Competence: A Pilot Randomized Trial

Journal of Clinical Medicine ◽

10.3390/jcm8040469 ◽

2019 ◽

Vol 8 (4) ◽

pp. 469 ◽

Cited By ~ 7

Author(s):

Shanying Xiong ◽

Peng Zhang ◽

Zan Gao

Keyword(s):

Executive Functions ◽

Urban Areas ◽

Social Acceptance ◽

Intervention Group ◽

Perceived Competence ◽

Physical Competence ◽

Post Intervention ◽

Significant Difference ◽

Over Time ◽

Perceived Social Acceptance

Purpose: This study aimed to evaluate the effects of a child-centered exergaming program and a traditional teacher-led physical activity (PA) program on preschoolers’ executive functions and perceived competence. Methods: Sixty children aged 4–5 years from an urban childcare center in China completed an 8-week exergaming/traditional PA intervention. After baseline measurements of executive functions and perceived competence (i.e., perceived physical competence and social acceptance), children were randomly assigned to either an exergaming group or traditional PA group (30 children per group). Exergaming and traditional PA programs were offered 20 min/session by trained instructors for 8 weeks. Post-intervention measures were identical to baseline measures. Results: In general, children’s executive functions, perceived physical competence, and perceived social acceptance were enhanced over time. Analysis of variance revealed significant time by group interaction effects for executive functions, F(1, 58) = 12.01, p = 0.01, and perceived social acceptance, F(1, 58) = 6.04, p = 0.02, indicating that the exergaming intervention group displayed significantly greater increases in executive functions and perceived social acceptance in comparison with traditional PA children. In addition, children’s executive functions and perceived physical and social competence significantly improved from baseline to post-intervention. However, there was no significant difference in the increase of children’s perceived physical competence across groups over time. Conclusion: The results suggested exergaming to be beneficial in enhancing young children’s executive functions and perceived social acceptance compared to the traditional PA program. More diverse samples with a longer intervention duration in preschool children in urban areas are warranted.

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