Pilot study assessing the effect of osteopathic manipulative treatment (OMT) on length of stay in neonates after therapeutic hypothermia

2021 ◽  
Vol 121 (1) ◽  
pp. 97-104
Author(s):  
Kira Bendixen ◽  
Alexis Beinlich ◽  
Bryan Beck ◽  
Nabeel Hashmi ◽  
Alexa Craig
Keyword(s):  
Pilot Study ◽  
Length Of Stay ◽  
Therapeutic Hypothermia ◽  
Oral Feeding ◽  
Historical Control ◽  
Osteopathic Manipulative Treatment ◽  
Eligibility Criteria ◽  
Term Neonates ◽  
The Difference ◽  
Historical Controls

Abstract Context Term neonates treated with therapeutic hypothermia (TH) may experience delays in acquiring skills for oral feeding, thus prolonging hospital admission. Objective To determine whether osteopathic manipulative treatment (OMT) can decrease the overall length of stay (LOS) for term neonates by accelerating the transition to full oral feeds. Methods A pilot study was conducted to compare LOS in term neonates treated with OMT to matched historical controls. Eligibility criteria were gestational age greater than or equal to 37 weeks, mild to moderate encephalopathy, absent seizure activity, and no brain injury on magnetic resonance imaging. Treated neonates had OMT twice between day of life four and seven, then twice per week on nonconsecutive days until hospital discharge. Secondary outcomes were to compare the number of days with nasogastric tube in both OMT and historically matched control groups and to characterize somatic dysfunction patterns in the primary affected areas of the craniosacral mechanism. Results Twelve of 28 neonates treated with TH between October 2017 and August 2018 met eligibility criteria for the study and were matched 3:1 to 36 historical controls. On average, mothers of neonates who received OMT were older than the historical control mothers (31.3 years [SD, ±6.0] vs. 27.4 [SD, ±4.5]; p=0.02) Nineteen of the 36 historical control neonates, but no neonates in the OMT group, were intubated for a median of two days (interquartile range 1, 4). The mean LOS in the OMT group was 9.1 vs. 11.6 days for historical controls (p=0.048); however, in a sensitivity analysis excluding intubated neonates from the historical controls, the difference was 9.1 vs. 10.1 days (p=0.21). All neonates were orally feeding at discharge. Neonates given OMT had between two and four treatments lasting 8–20 minutes. By the final treatment, the craniosacral mechanism’s intraosseous and cranial base compressions and physiologic motion were improved. There were no adverse effects noted during OMT sessions. Conclusion Our findings suggest that OMT performed on term neonates treated with TH may decrease the amount of time needed to acquire the necessary skills for oral feeding. Although this result was not statistically significant, it may be clinically significant. A larger prospective clinical trial may have the power needed to detect a statistically significant reduction in LOS and number of days to full oral feeds in this patient population.

scholarly journals A RESISTÊNCIA ANTIMICROBIANA E CUSTOS DE CUIDADO DE SAÚDE: UMA REVISÃO SISTEMÁTICA

2022 ◽  
Vol 13 (2) ◽  
pp. 25-39
Author(s):  
Tiago de Oliveira Silva ◽  
Luis do Nascimento Ortega
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Prospective Study ◽  
Nosocomial Infections ◽  
Financial Resources ◽  
Eligibility Criteria ◽  
Antimicrobial Drugs ◽  
Levels Of Evidence ◽  
The Difference ◽  
A Prospective Study

There is a growing concern about the multi-resistant capabilities presented by microorganisms to antimicrobials. Society is harmed by the redirection of financial resources from other areas, also lacking the population, to purchase more potent antimicrobials and in larger quantities. This study describes the consumption of antimicrobial drugs and their impact generated through a systematic review, following the recommendations of the Prisma method. Searches were performed in four databases (Portal BVS, PubMed, Embase and Science Direct). A total of 196 articles were found, 11 of which were selected after applying the eligibility criteria. A prospective study showed that the difference in expenditures can reach $31.17 patients/day between prophylactics and those with nosocomial infections. Studies have shown that the increase in costs is related to the increase in the length of stay. Mortality and admission to the ICU also increased. Further studies with high levels of evidence are recommended.

Predictors of Success Using a mHealth Intervention in Adults with Prediabetes: Results of a Pilot Study (Preprint)

2019 ◽  
Author(s):  
Nestoras Mathioudakis ◽  
Estelle Everett ◽  
Noora Al-Hajri ◽  
Mohammed Abusamaan ◽  
Clare Lee ◽  
...  
Keyword(s):  
Pilot Study ◽  
Intervention Program ◽  
Area Deprivation ◽  
Inverse Association ◽  
Small Pilot Study ◽  
Mhealth Intervention ◽  
Increased Risk ◽  
Metabolic Equivalent Of Task ◽  
Mobile Intervention ◽  
The Difference

BACKGROUND About one-third of American adults have prediabetes and are at increased risk of type 2 diabetes. Mobile health (mHealth) technologies provide a scalable approach to diabetes prevention by encouraging physical activity (PA), weight loss, and adherence to a healthy diet in large numbers of patients. OBJECTIVE To identify factors associated with improvements in PA and glycated hemoglobin (A1c) measures among prediabetic adults who received a mobile intervention program (smartphone app in combination with a digital body weight scale) in a previously completed pilot study. METHODS We conducted a post hoc analysis of a 3-month prospective, single-arm, observational study using the Sweetch™ mHealth intervention among adults with prediabetes. Change in A1C was calculated as the difference between the 3-month and baseline A1C measurements and was categorized as decrease vs. no decrease. PA was evaluated using the total minutes and metabolic equivalent of task (MET)-hours per week. Change in MET-hours/week was categorized as increase vs. no increase. Age, sex, race, education, employment status, area deprivation, smartphone usage attitudes, and PA stage of change were compared between groups by outcomes of change in A1C and change in MET-hour/week. RESULTS A total of 37 adults received the final Sweetch mobile intervention and were included in the analysis. 62% were female and 81% were white, with average age of 57 years. The median [IQR] baseline A1C was 6.0% [5.8, 6.2]. A1C measure at 3-month was decreased in 24 (65%) participants when compared to baseline A1C. There was an inverse association between average MET-hours per week and change in A1C. Among participants whose A1C decreased vs. did not decrease, the MET-hours per week in last 2 weeks of study was 18.7 (8.4) and 15.0 (7.1), respectively (P=0.19), and the change in MET-hours per week was 2.1 (7.1) and 4.1(6.1), respectively (P=0.41). There were otherwise no statistically significant differences in participant factors by A1C and PA outcomes. CONCLUSIONS In this small pilot study, Sweetch mHealth intervention achieved comparable A1C response prediabetic adults with different individual, sociodemographic and anthropometric characteristics. CLINICALTRIAL ClincialTrials.gov NCT02896010; https://clinicaltrials.gov/ct2/show/NCT02896010 (Archived by WebCite at http://www.webcitation.org/6xJYxrgse)

39 Managing Burn Wounds with Silvadene

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S29-S30
Author(s):  
Tomer Lagziel ◽  
Louis J Born ◽  
Luis H Quiroga ◽  
Eliana Duraes ◽  
Pragna N Shetty ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Wound Infection ◽  
Standard Of Care ◽  
Infection Rates ◽  
Average Amount ◽  
Once Daily ◽  
Preliminary Results ◽  
The Difference ◽  
Dressing Change ◽  
Hospital Acquired

Abstract Introduction Topical delivery of antibacterial agents is typically incorporated and is an essential component of burn wound therapy. The goal is to prevent infection and promote the healing process. Poorly treated wounds can result in scarring or severely in sepsis and multi-organ dysfunction. Topical SSD cream has been the gold-standard for initial local care in partial thickness or full thickness burns. Due to immediate burst release of the drug into the exposed areas, application is relatively frequent (usually twice daily). However, it remains unknown whether twice-daily SSD dressings are superior to once-daily. Methods We maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once-daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after. The main outcomes recorded are wound infection rates, hospital-acquire complications (non-wound related), pain scores, daily narcotic requirements, average amount of SSD used, and length-of-stay. Results Preliminary results of the 75 pre-change-of-practice and 75 post-change-of-practice patients showed slightly better outcomes in the post-change group. Wound-infection rates were the same for both groups (pre=5.33%, post=5.33%), average daily pain-levels for the pre-change group were slightly higher but the difference was negligible and not statistically significant (pre=5.76, post=5.69). The pre-change group had a higher average daily narcotic dosage (pre=6.81mg, post=6.38mg), hospital-acquired complication rates were higher pre-change (pre=10.67%, post=6.67%), and length-of-stay was longer in the pre-change group (pre=10.81, post=9.25). The average amount of SSD jars used per patient was higher as well (pre=6.30, post=2.85). Statistical analysis of the distribution of burn type, age, and burn depth showed no discrepancy and a generalized decreased length-of-stay with once-daily SSD dressing change. Conclusions Preliminary results show that once-daily dressing changes of SSD in burn wounds have no negative impact on wound outcomes. However, it is associated with a decreased length-of-stay, decreased pain levels, and less hospital-acquired complications. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. In addition, less hospital-acquired complications result in better patient recovery. Since the difference in wound outcomes is negligible and statistically insignificant, changing the standard-of-care to once-daily could prove beneficial.

scholarly journals Risk factors for thoracolumbar pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052198946
Author(s):  
Xiaoguang Fan ◽  
Sha Li ◽  
Xianshang Zeng ◽  
Weiguang Yu ◽  
Xiangzhen Liu
Keyword(s):  
Risk Factors ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Mineral Density ◽  
Eligibility Criteria ◽  
Compression Fractures ◽  
Logistic Analysis ◽  
The Difference ◽  
Poor Outcomes

Objective To explore possible risk factors for poor outcomes following percutaneous vertebroplasty (PV) for painful osteoporotic compression fractures of thoracolumbar vertebra. Methods This was a retrospective review of data from patients who underwent PV at our institution over a ten-year period to evaluate the association between possible risk factors and thoracolumbar pain (T11-L2). According to the difference between pre- and post-operative visual analogue scale (VAS) scores for pain, patients were separated into poor relief (PR; <4) and good relief (GR; ≥4) of pain. Results Of the 750 patients identified, 630 (PR group, n =310; GR group, n = 320) fulfilled the eligibility criteria. Multivariate binary logistic analysis showed that bone mineral density (BMD), >2 fractured vertebral bodies, maldistribution of bone cement, <5 ml bone cement injected into a single vertebral body and thoracolumbar fascia injury prior to surgery were independent risk factors associated with thoracolumbar pain following PV. Conclusion Although prospective controlled studies are required to confirm our results, this review suggests that the above factors should be taken into account when selecting patients for PV.

scholarly journals 0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A225-A225
Author(s):  
J Xue ◽  
R Zhao ◽  
J Li ◽  
L Zhao ◽  
B Zhou ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulse Oximeter ◽  
Characteristic Curve ◽  
Diagnostic Value ◽  
Receiver Operator Characteristic Curve ◽  
Oxygen Desaturation ◽  
Significant Difference ◽  
Acceptance Range ◽  
The Difference ◽  
Two Parameters

Abstract Introduction To evaluate the utility of the ring pulse oximeter for screening of OSA in adults. Methods 87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15). Results Among the 87 participants, 18 cases were AHI&lt;5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P&gt;0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p&lt;0.05). Although MSpO2 correlated significantly (r=0.448, P&lt;0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p&lt;0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively. Conclusion The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA. Support The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).

Geriatric Inclusive Art and Length of Stay in Acute Care Unit: A Case-Control Pilot Study

2012 ◽  
Vol 60 (8) ◽  
pp. 1585-1587 ◽  
Author(s):  
Olivier Beauchet ◽  
Samantha Remondière ◽  
Micheline Mahé ◽  
Florence Repussard ◽  
Frederic Decavel ◽  
...  
Keyword(s):  
Pilot Study ◽  
Length Of Stay ◽  
Acute Care ◽  
Case Control ◽  
Acute Care Unit

scholarly journals 1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Jessica Snawerdt ◽  
Derek N Bremmer ◽  
Dustin R Carr ◽  
Thomas L Walsh ◽  
Tamara Trienski ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Post Intervention ◽  
Significant Difference ◽  
Educational Campaign ◽  
The Difference ◽  
Hospital Acquired ◽  
Culture Acquisition

Abstract Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

scholarly journals Cost-minimisation analysis alongside a pilot study of early Tissue Doppler Evaluation of Diastolic Dysfunction in Emergency Department Non-ST Elevation Acute Coronary Syndromes (TEDDy-NSTEACS)

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023920 ◽  
Author(s):  
Vijay S Gc ◽  
Mohamad Alshurafa ◽  
David J Sturgess ◽  
Joseph Ting ◽  
Kye Gregory ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
High Risk ◽  
Length Of Stay ◽  
Cost Saving ◽  
Risk Stratification ◽  
Diagnostic Tool ◽  
Tissue Doppler ◽  
Conventional Care ◽  
St Elevation

ObjectiveTo estimate the cost implications of early angiography for patients with suspected non-ST elevation acute coronary syndrome (NSTEACS) using tissue Doppler imaging (TDI).DesignA decision tree model was used to synthesise data from the pilot study and literature sources. Sensitivity analyses tested the impact of assumptions incorporated into the analysis.SettingEmergency department (ED), Brisbane, Australia.ParticipantsPatients with suspected NSTEACS.InterventionsTDI as a diagnostic tool for triaging patients within 4 hours of presentation in addition to conventional risk stratification, compared with conventional risk stratification alone.Data sourcesResource used for diagnosis and management were recorded prospectively and costed for 51 adults who had echocardiography within 24 hours of admission. Costs for conventional care were based on observed data. Cost estimates for the TDI intervention assumed patients classified as high risk at TDI (E/e’>14) progressed early to angiography with an associated 1-day reduction in length of stay.Primary outcome measuresCosts until discharge from the Australian healthcare perspective in 2016–2017 prices.ResultsFindings suggest that using TDI as a diagnostic tool for triaging patients with suspected NSTEACS is likely to be cost saving by $A1090 (95% credible interval: $A573 to $A1703) per patient compared with conventional care. The results are mainly driven by the assumed reduction in length of stay due to the inclusion of early TDI in clinical decision-making.ConclusionsThis pilot study indicates that compared with conventional risk stratification, triaging patients presenting with suspected NSTEACS with TDI within 4 hours of ED presentation has potential cost savings. Findings assume a reduction in hospital stay is achieved for patients considered to be high risk at TDI. Larger, comparative studies with longer follow-up are needed to confirm the clinical effectiveness of TDI as a diagnostic strategy for NSTEACS, the assumed reduction in hospital stay and any cost saving.

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