scholarly journals An Integrative Care Model of Clinical Pathway Approach for Acute Pain after Back Surgery: A Protocol for Clinical Trial

2017 ◽  
Vol 27 (4) ◽  
pp. 111-119 ◽  
Author(s):  
Byung-Jun Kim ◽  
Byung-Cheul Shin ◽  
Man-suk Hwang ◽  
Kyung-Min Shin ◽  
In Heo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Acute Pain ◽  
Clinical Pathway ◽  
Integrative Care ◽  
Care Model ◽  
Back Surgery

A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases.

2021 ◽  
pp. 1357633X2110597
Author(s):  
Carlos Hernandez-Quiles ◽  
Máximo Bernabeu-Wittel ◽  
Bosco Barón-Franco ◽  
Alfonso Aguirre Palacios ◽  
M Rocio Garcia-Serrano ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Functional Status ◽  
Integrated Care ◽  
Lung Diseases ◽  
Care Model ◽  
Emergency Admissions ◽  
Perceived Satisfaction ◽  
Lung Failure ◽  
Functional Features

Brief Summary The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. Background Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). Objective To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. Design Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. Participants Five spanish centers including patients with AHLF at discharge or in out-patient clinics. Intervention Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. Main Measures Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. Results 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). Conclusions The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

scholarly journals Using Stories to Communicate Individual Risk for Opioid Prescriptions: Study Protocol for the Life STORRIED Multicenter Randomized Clinical Trial

2018 ◽  
Author(s):  
Zachary F Meisel ◽  
Esha Bansal ◽  
Marilyn M Schapira ◽  
Jeanmarie Perrone ◽  
Carolyn C Cannuscio ◽  
...  
Keyword(s):  
United States ◽  
Clinical Trial ◽  
Risk Communication ◽  
Randomized Clinical Trial ◽  
Acute Care ◽  
Acute Pain ◽  
The United States ◽  
Risk Information ◽  
Information Sheet ◽  
Health Crisis

Abstract Background: Prescription opioid abuse in the United States is a devastating public health crisis, of which many chronic opioid users were originally prescribed the medication for acute pain. Narrative enhanced risk communication may improve patient outcomes such as knowledge of opioid risk and opioid use behaviors in the setting of acute pain. Methods & Design: Patients presenting to the acute care facilities of four geographically and ethnically diverse United States hospital centers with renal colic or musculoskeletal back pain will be eligible for this multicenter randomized clinical trial. A control group of patients receiving a standardized, general risk information sheet will be compared to two intervention groups, one receiving the risk information sheet plus a probabilistic opioid risk tool and another receiving the risk information sheet plus a narrative enhanced probabilistic opioid risk tool. We will study the effect of probabilistic and narrative enhanced opioid risk communication on: 1) knowledge as measured by risk awareness and treatment preferences for fewer opioids; 2) reduced use of opioids as measured by quantity of opioids taken, functional improvement, and repeat use of unscheduled visits for pain; 3) patient-provider alignment as measured by concordance between patient preference and finalized prescription plan and the presence of shared decision making. To assess these outcomes, we will administer baseline patient surveys during acute care admission and follow-up surveys at predetermined times during the ninety days after discharge. Discussion: This study seeks to assess the potential clinical role of narrative enhanced, risk-informed communication for acute pain management in acute care settings. This paper outlines the protocol used to implement the study and highlights crucial methodological, statistical, stakeholder involvement, and dissemination considerations.

scholarly journals Clinical trial designs and models for analgesic medications for acute pain in neonates, infants, toddlers, children, and adolescents

Pain ◽  
2018 ◽  
Vol 159 (2) ◽  
pp. 193-205 ◽  
Author(s):  
Gary A. Walco ◽  
Ernest A. Kopecky ◽  
Steven J. Weisman ◽  
Jennifer Stinson ◽  
Bonnie Stevens ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Children And Adolescents ◽  
Acute Pain ◽  
Clinical Trial Designs

Photobiomodulation therapy (PBMT) on acute pain and inflammation in patients who underwent total hip arthroplasty—a randomized, triple-blind, placebo-controlled clinical trial

2018 ◽  
Vol 33 (9) ◽  
pp. 1933-1940 ◽  
Author(s):  
Luciana Gonçalves Langella ◽  
Heliodora Leão Casalechi ◽  
Shaiane Silva Tomazoni ◽  
Douglas Scott Johnson ◽  
Regiane Albertini ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acute Pain ◽  
Photobiomodulation Therapy ◽  
Controlled Clinical Trial ◽  
Total Hip

The effect of continuous care model-based intervention on the quality of sleep in menopausal women: A clinical trial study

2019 ◽  
Author(s):  
Farzaneh AKBARI ◽  
sousan Heydarpour ◽  
Nader Salari
Keyword(s):  
Clinical Trial ◽  
Intervention Group ◽  
Control Group ◽  
Quality Of Sleep ◽  
Care Model ◽  
Continuous Care ◽  
Menopausal Women ◽  
Significant Difference ◽  
The Difference

Abstract BACKGROUND Sleep disorder, brings in many physical, behavioral, and mental problems. Applying continuous care model leads to proper recognition of the patient’s problems and involves the patient in solving health problems. This study aimed to determine the effect of continuous care model on the quality of sleep in menopausal women. METHODS AND MATERIALS A random clinical trial study was carried out with participation of 110 menopausal women visiting Kermanshah-based clinics (the west of Iran) in 2017. The participants were randomly assigned to intervention (n=55) and control (n=55) groups. The control group received the routine cares and in addition to the routine cares the intervention group attended four weekly group consultation sessions (60-90min). The quality of sleep in the two groups was assessed using Pittsburg Sleep Quality Index before, immediately after, and one month after the intervention. Data analyses were done using independent t-test, ANOVA with frequent measures, Friedman’s test, Wilcoxon’s post hoc test, and X2 test in SPSS (24). RESULTS The mean scores of quality of sleep before and after the intervention were significantly different in the intervention group (p=0.001). There was no significant difference between the two groups in terms of quality of sleep before (p=0.140) and immediately after the intervention (p=0.168). However, one month after, the difference between the two groups was significant (P<0.001). CONCLUSION Implementation of the continuous care model led to an improvement of quality of sleep in the menopausal women.

Integrative Care Model for Neurology and Psychiatry

2017 ◽  
Author(s):  
Lynne Fenton ◽  
Brian Rothberg ◽  
Laura Strom ◽  
Allison M. Heru ◽  
Mesha-Gay Brown
Keyword(s):  
Psychiatric Treatment ◽  
Treatment Approach ◽  
Epileptiform Activity ◽  
Epileptic Seizures ◽  
Integrated Treatment ◽  
Psychiatric Evaluation ◽  
Effective Management ◽  
Integrative Care ◽  
Care Model ◽  
Nonepileptic Seizures

Nonepileptic seizures resemble epileptic seizures but lack epileptiform activity on an electroencephalogram and presumably have psychopathologic origins. Psychiatric comorbidities are common, and effective management requires psychiatric treatment. Unfortunately, many patients fear that seeing a psychiatrist implies their episodes are not being taken seriously and that their neurologist might perceive them as producing their symptoms willfully. Patients might feel abandoned if their neurologist refers them to a psychiatrist and indicates that they no longer need to be seen by the neurologist. Consequently, patients often resist undergoing psychiatric evaluation. To help address this problem our team piloted a program integrating psychiatric and neurologic approaches, placing a therapeutic treatment group within the neurology outpatient department. This chapter reviews the clinical features of non-epileptic seizures, including diagnosis and treatment, and presents our team’s integrated treatment approach.

An Acute Pain Service experience initiating methadone for opioid use disorder in hospitalized patients with acute pain

2019 ◽  
Vol 15 (4) ◽  
pp. 275-283
Author(s):  
Rebecca C. Dale, DO ◽  
Carol L. Metcalf, MN, ARNP ◽  
Dale J. Langford ◽  
Christina E. Bockman, PharmD ◽  
Debra B. Gordon, DNP, RN, FAAN ◽  
...  
Keyword(s):  
Acute Pain ◽  
Clinical Pathway ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Hospitalized Patients ◽  
Acute Pain Service ◽  
Opioid Use ◽  
Post Discharge ◽  
Frequency Distributions ◽  
Average Maximum

Objective: Inform readers of the use of a clinical pathway that includes initiation of methadone in hospitalized patients with acute pain who have untreated opioid use disorder (OUD).Design: A retrospective chart review with frequency distributions and descriptive statistics calculated to describe demographic and clinical characteristics of the sample.Setting: Urban academic hospital.Patients: One hundred twenty consecutive patients with untreated OUD cared for by the Acute Pain Service (APS).Interventions: APS leadership spearheaded development of a clinical pathway to standardize pain management and optimize outcomes. The authors outline pathway development and describe 120 patients managed using this pathway, initiated on methadone for OUD.Results: The sample included patients, average age 40 years, predominantly non-Hispanic white (74.2 percent), male (61.7 percent), unemployed (88.2 percent), and on Medicaid (84.2 percent). 96.7 percent had a history of heroin use, and 52.1 percent had engaged in previous medication-assisted treatment (MAT). Methadone or other opioids were held for signs of intoxication/sedation in 10.9 percent or for prolonged corrected QT interval in 1.7 percent. The majority received at least one other analgesic agent. For those prescribed opioids upon discharge, the average maximum morphine equivalent dose was 68.2 mg/day for approximately 3 days. 68.3 percent agreed to schedule post-discharge MAT, and of these, 68 percent attended their intake appointment. A small percentage (4.7 percent) left the hospital against medical advice.Conclusion: This pathway provides an example of an effective and safe response to address the opioid epidemic and provide quality care to patients with OUD and pain.

Effects of a clinical pathway on quality of care in kidney transplantation: a non-randomized clinical trial

2009 ◽  
Vol 395 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Matthias Schwarzbach ◽  
Roderich Bönninghoff ◽  
Katrin Harrer ◽  
Johannes Weiss ◽  
Christof Denz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Quality Of Care ◽  
Kidney Transplantation ◽  
Randomized Clinical Trial ◽  
Clinical Pathway
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