Effect of targeted fluid minimization and diuretic therapy on hospital- acquired heart failure and adverse outcomes in patients with no preexisting cardiac dysfunction

Abstract Background This study aimed to investigate: 1) the incidence of hospital-acquired heart failure (HF) in patients with no preexisting cardiac disorder, and 2) whether the use of an intervention protocol comprised of targeted fluid minimization and diuretic therapy can reduce the incidence of hospital-acquired HF and adverse outcomes.Methods We conducted a single-center, open-labeled, prospective cohort study enrolling patients with no preexisting cardiac dysfunction who were admitted to the medical wards and had a positive intravenous fluid balance > 4 L within 3 days. We assigned patients in a 1:1 ratio to the intervention protocol (intervention group) or usual care. The primary outcome was hospital-acquired HF. The secondary outcomes included in-hospital mortality, intensive critical unit (ICU) admission, mechanical ventilator usage, or prolonged hospital stay > 30 days.Results A total of 98 patients (mean age 66; 52% male) were enrolled (intervention group, 49; usual care group, 49). The incidence of hospital-acquired HF among all patients was 21%. Patients with hospital-acquired had higher rates of in-hospital mortality (48% vs.13%; p = 0.001), ICU admission (33% vs.10%; p = 0.010) and mechanical ventilator usage (62% vs. 35%; p = 0.027). Prolonged hospital stay > 30 days rates were similar in patients with and without hospital-acquired HF. Hospital-acquired HF was not found statistically different between groups (intervention group 18% vs. usual care group 25%; p = 0.460). Patients in the intervention group did have lower rates of subsequent ICU admission (8%vs.23%; p = 0.049) and hospitalizattion > 30 days. (8%vs.27%; p = 0.018) compared with the usual care group. In-hospital mortality and mechanical ventilator usage were not different between groups.Conclusions The incidence of hospital-acquired HF in patients with no preexisting cardiac dysfunction who had a positive cumulative fluid balance of > 4 L within 3 days was not uncommon, about one in five patients. Hospital-acquired HF can lead to increased in-hospital mortality and co-morbidities. Targeted fluid minimization and diuretics did show a reduced rate of ICU admission and prolonged hospitalization. However, no statistical difference in rates of hospital-acquired HF and in-hospital mortality compared to the control group were found.

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Thalidomide for the treatment of severe Covid-19: A randomized clinical trial

10.21203/rs.3.rs-379635/v1 ◽

2021 ◽

Author(s):

Babak Amra ◽

Farzaneh Ashrafi ◽

Forogh Soltaninejad ◽

Awat Feizi ◽

Mehrzad Salmasi

Keyword(s):

Clinical Trial ◽

Usual Care ◽

Randomized Clinical Trial ◽

Usual Care Group ◽

Intervention Group ◽

Admission Rate ◽

Lung Damage ◽

Care Group ◽

Icu Admission ◽

Usual Treatment

Abstract Background Covid-19 pneumonia is the leading cause of death in severe hospitalized patients. Thalidomide has an immunomodulatory and anti-inflammatory effect and thereby decrease lung damage.Methods This study was a randomized clinical trial that was performed from April 2020 until August 2020 on 60 severe hospitalized Covid-19 pneumonia patients. All patients received the usual care for Covid-19 pneumonia based on our hospital protocols. Patients in the intervention group received thalidomide tablets 100 mg daily for 14 days added to the usual treatment. The primary outcome was the ICU admission rate.Results Thirty patients were assigned to receive thalidomide and 30 patients usual treatment. Five patients (17.9%) in the thalidomide group required ICU admission and 12 patients (52.2%) in the usual care group (P-value = 0.01). ICU admission hazard ratio was 3.3 higher in the usual care group than the thalidomide group (HR: 3.31 [95% CI: 1.16–9.45]). Hospitalization duration, intubation and mortality showed no significant differences between the two groups (P > 0.05 for all items). No serious and major adverse effects were reported during the trial.Conclusion The use of thalidomide was associated with a decreased rate of ICU admission in severe hospitalized covid-19 patients.

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Effect of Artificial Intelligence on Nutritional Status of children post cardiac surgery; A Randomized Controlled Trial (Preprint)

10.2196/preprints.36480 ◽

2022 ◽

Author(s):

Maryam Zahid ◽

Ume Sughra

Keyword(s):

Nutritional Status ◽

Usual Care ◽

Usual Care Group ◽

Mobile Application ◽

Controlled Trial ◽

Intervention Group ◽

Care Group ◽

Randomized Controlled ◽

Nutritional Status Of Children ◽

Post Cardiac Surgery

BACKGROUND Malnutrition is the most common problem in congenital heart diseases patients. Health based mobile applications play an important role in planning and tracking of diet for better nutritional status OBJECTIVE To assess the effect of artificial intelligence on nutritional status of children post cardiac surgery in comparison to usual care group. To assess usefulness of diet related mobile application in comparison to usual care group. METHODS This is a two arm randomized controlled trial that was conducted at a Tertiary Care Hospital, Rawalpindi. The study duration was 6 months from February 2021 till July 2021. Sample size was calculated to be 88. Intervention group was given a diet related mobile application and usual care group was handed a pamphlet with diet instructions on discharge. RESULTS Mean weight of all participants was 15 ± 5.7 kg at the time of discharge whereas at the end of 8th week mean weight of the participants in usual care group was 16.5 ± 7.2 kg and intervention group was 17.1 ± 5 kg. Average calories consumed by usual care group was 972 ± 252 kcal and 1000.75 ± 210 kcal by intervention group after 8 weeks of discharge. Average proteins consumed by the usual care group was 34.3 ± 12.5 grams and 39± 6.4 grams by intervention group after 8 weeks of discharge. At the end of intervention preferred diet planning tool for 79% of the participants was mobile application. At 8th week 93% of the participants considered the visual cues useful, 80% think that the mobile application language was understandable, 79% of the participants think nutritional goal setting is a useful feature in mobile application and 55% of the participants think the recipes in the application were useful. CONCLUSIONS The study showed strength for the future of scalable modern technology for self-nutrition monitoring. There was slight increase in the weight and nutritional intake of both groups as interventions period was limited. CLINICALTRIAL Study was registered on clinicaltrial.gov website with trial identity number NCT04782635.

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A Proactive Telephone-Delivered Risk Communication Intervention for Smokers Participating in Lung Cancer Screening: A Pilot Feasibility Trial

The Journal of Smoking Cessation ◽

10.1017/jsc.2017.16 ◽

2017 ◽

Vol 13 (3) ◽

pp. 137-144 ◽

Cited By ~ 2

Author(s):

Steven B. Zeliadt ◽

Preston A. Greene ◽

Paul Krebs ◽

Deborah E. Klein ◽

Laura C. Feemster ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Usual Care ◽

Usual Care Group ◽

Intervention Group ◽

Lung Cancer Screening ◽

Feasibility Trial ◽

Care Group ◽

Telephone Counselling ◽

Tobacco Treatment

Introduction: Many barriers exist to integrating smoking cessation into delivery of lung cancer screening including limited provider time and patient misconceptions.Aims: To demonstrate that proactive outreach from a telephone counsellor outside of the patient's usual care team is feasible and acceptable to patients.Methods: Smokers undergoing lung cancer screening were approached for a telephone counselling study. Patients agreeing to participate in the intervention (n = 27) received two telephone counselling sessions. A 30-day follow-up evaluation was conducted, which also included screening participants receiving usual care (n = 56).Results/Findings: Most (89%) intervention participants reported being satisfied with the proactive calls, and 81% reported the sessions were helpful. Use of behavioural cessation support programs in the intervention group was four times higher (44%) compared to the usual care group (11%); Relative Risk (RR) = 4.1; 95% CI: 1.7 to 9.9), and seven-day abstinence in the intervention group was double (19%) compared to the usual care group (7%); RR = 2.6; 95% CI: 0.8 to 8.9).Conclusions: This practical telephone-based approach, which included risk messages clarifying continued risks of smoking in the context of screening results, suggests such messaging can boost utilisation of evidence-based tobacco treatment, self-efficacy, and potentially increase the likelihood of successful quitting.

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Interdisciplinary palliative care for patients with lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.130 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 130-130

Author(s):

Betty R. Ferrell ◽

Virginia Sun ◽

Arti Hurria ◽

Mihaela C. Cristea ◽

Dan Raz ◽

...

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Psychological Distress ◽

Supportive Care ◽

Usual Care ◽

Usual Care Group ◽

Intervention Group ◽

Well Being ◽

Care Group ◽

Ambulatory Care Setting

130 Background: Palliative care, including symptom management and attention to quality of life (QOL) concerns, should be addressed throughout the trajectory of a serious illness such as lung cancer. This study tested the effectiveness on an interdisciplinary palliative care intervention for patients with stage I-IV non-small cell lung cancer (NSCLC). Methods: Patients undergoing treatments for NSCLC were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. Patients in the intervention group were presented at interdisciplinary care meetings and appropriate supportive care referrals were made. They also received four educational sessions. In both groups, QOL, symptoms, and psychological distress were assessed at baseline and 12 weeks using surveys which included the FACT-L, FACIT-Sp-12, LCS, and the Distress Thermometer. Results: A total of 491 patients were included in the primary analysis. Patients who received the intervention had significantly better scores for QOL (109.1 vs. 101.4; p < .001), symptoms (25.8 vs. 23.9; p < .001), spiritual well-being (38.1 vs. 36.2; p < .001), and lower psychological distress (2.2 vs. 3.3; p < .001) at 12 weeks, after controlling for baseline scores, compared to patients in the usual care group. Patients in the intervention group also had significantly higher numbers of completed advance care directives (44% vs. 9%; p < .001), and overall supportive care referrals (61% vs. 28%; p < .001). Conclusions: Interdisciplinary palliative care in the ambulatory care setting resulted in significant improvements in QOL, symptoms, and distress for NSCLC patients.

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Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

Pharmacy Practice ◽

10.18549/pharmpract.2021.3.2402 ◽

2021 ◽

Vol 19 (3) ◽

pp. 2402

Author(s):

Emmanuel A. David ◽

Rebecca O. Soremekun ◽

Isaac O. Abah ◽

Roseline I. Aderemi-Williams

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Usual Care ◽

Usual Care Group ◽

Intervention Group ◽

Glycated Haemoglobin ◽

Care Group ◽

Laboratory Parameters ◽

Randomised Controlled

Background: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. Objective: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes Methods: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. Conclusions: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

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Test of weight gain prevention intervention in stage II and III breast cancer patients receiving neoadjuvant chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20523 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20523-e20523 ◽

Cited By ~ 1

Author(s):

K. Basen-Engquist ◽

H. Y. Perkins ◽

C. L. Carmack Taylor ◽

D. C. Hughes ◽

J. L. Jovanovic ◽

...

Keyword(s):

Breast Cancer ◽

Weight Gain ◽

Neoadjuvant Chemotherapy ◽

Usual Care ◽

Cancer Patients ◽

Usual Care Group ◽

Intervention Group ◽

Care Group ◽

Weight Gain Prevention ◽

Breast Cancer Patients

e20523 Background: Weight gain is common in women with breast cancer and is worrisome, as may affect prognosis and risk of other chronic diseases. This randomized study pilot tested a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy. Methods: Breast cancer patients receiving neoadjuvant chemotherapy were randomized to a weight gain prevention intervention or a usual care control arm. The intervention used a body acceptance approach, which emphasized changes in diet (low energy density food) and exercise behavior (resistance training) rather than focusing on weight loss. It was administered in weekly sessions delivered in-person and by telephone. Assessments were done at baseline, mid-chemotherapy, pre-surgery, after surgical recovery, after a 9 week post-surgical booster intervention, and 6 months after surgery. The data on weight changes from baseline (T0) to mid-chemotherapy (T1) and presurgery (T2) is presented. Results: 33 participants were randomized the intervention (n=16) or usual care (n=17). Three control participants withdrew before assessments were done. Of the 30 remaining women, 70% had stage II and 30% had stage III breast cancer. Their mean age was 49.7 (SD=12.2), and half were premenopausal. Mean BMI was 29.3 (SD=6.1) and 70% were physically inactive. The sample was diverse with regard to self-reported ethnicity (57% white, 27% African-American, 7% Hispanic, 10% other). Change in weight from T0 to T1 was -0.9 kg in the intervention group and +1.4 kg in the usual care group (n=27, p=0.126); from T0 to T2 the change was -2.0 kg in the intervention group and +0.8 kg in the usual care group (n=20, p=0.056). When weights from a chart review were used for patients with missing assessments the T0 to T2 changes were -2.9 kg for the intervention group and 0 kg for the usual care group (n=30, p=0.065). Conclusions: Based on a preliminary analysis, there was a trend approaching statistical significance for weight loss from a diet and exercise intervention based on the body acceptance approach compared to a usual care control group. These results indicate this intervention should be tested in a larger randomized controlled trial. No significant financial relationships to disclose.

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Home-Based Kidney Care, Patient Activation, and Risk Factors for CKD Progression in Zuni Indians

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06910618 ◽

2018 ◽

Vol 13 (12) ◽

pp. 1801-1809 ◽

Cited By ~ 6

Author(s):

Robert G. Nelson ◽

V. Shane Pankratz ◽

Donica M. Ghahate ◽

Jeanette Bobelu ◽

Thomas Faber ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Confidence Interval ◽

Usual Care ◽

Usual Care Group ◽

Short Form ◽

Intervention Group ◽

Patient Activation ◽

Care Group ◽

Home Based

Background and objectivesThe burden of CKD is greater in ethnic and racial minorities and persons living in rural communities, where access to care is limited.Design, setting, participants, & measurementsA 12-month clinical trial was performed in 98 rural adult Zuni Indians with CKD to examine the efficacy of a home-based kidney care program. Participants were randomized by household to receive usual care or home-based care. After initial lifestyle coaching, the intervention group received frequent additional reinforcement by community health representatives about adherence to medicines, diet and exercise, self-monitoring, and coping strategies for living with stress. The primary outcome was change in patient activation score, which assesses a participant’s knowledge, skill, and confidence in managing his/her own health and health care.ResultsOf 125 randomized individuals (63 intervention and 62 usual care), 98 (78%; 50 intervention and 48 usual care) completed the 12-month study. The average patient activation score after 12 months was 8.7 (95% confidence interval, 1.9 to 15.5) points higher in the intervention group than in the usual care group after adjusting for baseline score using linear models with generalized estimating equations. Participants randomized to the intervention had 4.8 (95% confidence interval, 1.4 to 16.7) times the odds of having a final activation level of at least three (“taking action”) than those in the usual care group. Body mass index declined by 1.1 kg/m2 (P=0.01), hemoglobin A1c declined by 0.7% (P=0.01), high-sensitivity C-reactive protein declined by 3.3-fold (P<0.001), and the Short-Form 12 Health Survey mental score increased by five points (P=0.002) in the intervention group relative to usual care.ConclusionsA home-based intervention improves participants’ activation in their own health and health care, and it may reduce risk factors for CKD in a rural disadvantaged population.

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Predictors of Change in Osteoporosis Knowledge, Health Beliefs, and Self-Efficacy After an Education Intervention

Innovation in Aging ◽

10.1093/geroni/igaa057.1466 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 453-453

Author(s):

Philippe Ronel Labrias ◽

Richard Feinn ◽

Shanthi Johnson ◽

Katherine McLeod

Keyword(s):

Usual Care ◽

Health Beliefs ◽

Self Efficacy ◽

Usual Care Group ◽

Intervention Group ◽

Care Group ◽

Education Intervention ◽

Mineral Density ◽

Osteoporosis Knowledge ◽

Bone Mineral Density Testing

Abstract Education interventions that increase osteoporosis knowledge and address health beliefs and self-efficacy help older adults make informed decisions to prevent and manage the disease. The aim of this study was to determine if clinical risk factors for osteoporosis moderate the effect of a multifaceted education intervention on osteoporosis knowledge, health beliefs, and self-efficacy. Patients 50 years and older with no prior diagnosis of or treatment for osteoporosis were referred by their primary care provider for bone mineral density testing by DXA and randomized to an osteoporosis education intervention group (n = 102) or usual care group (n = 101). Demographic and health history questionnaires, and validated tools to assess osteoporosis knowledge, health beliefs and self-efficacy were completed at baseline and 6-month follow-up. Results of the linear mixed-effects model showed a significant interaction with younger age (p=.024) on self-efficacy among patients in the intervention group compared to the usual care group. Patients with higher BMI had greater perceived health motivation (p=.026) in the intervention group. Compared to the usual care group, patients in the intervention group with higher vitamin D intake had greater perceived exercise (p=.020) and calcium benefits (p=.012) and those with a family history of osteoporosis had greater perceived susceptibility to osteoporosis (p=.045). By understanding the key factors that predict change in knowledge, health beliefs and self-efficacy after an education intervention compared to usual care, we can better tailor interventions to enhance prevention and management of osteoporosis.

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Preparing Families of Intensive Care Patients for Withdrawal of Life Support: A Pilot Study

American Journal of Critical Care ◽

10.4037/ajcc2008.17.2.113 ◽

2008 ◽

Vol 17 (2) ◽

pp. 113-121

Author(s):

Karin T. Kirchhoff ◽

Jenna Palzkill ◽

Jennifer Kowalkowski ◽

Anne Mork ◽

Elfa Gretarsdottir

Keyword(s):

Intensive Care ◽

Usual Care ◽

Usual Care Group ◽

Life Support ◽

Negative Mood ◽

Self Regulation ◽

Intervention Group ◽

Care Group ◽

Specific Information ◽

Tailored Messages

Background Most deaths in intensive care occur after withdrawal of life support. Although preparation of patients’ families is recommended, the specific information required has not been theoretically developed or tested. Objective To assess the feasibility of testing 4 tailored messages to prepare families of patients having a planned withdrawal of life support, to assess barriers to conducting such a study, and to obtain preliminary data on measurable effects that could be used to compare such preparation with usual care. Self-regulation theory was used to structure the messages. Methods Families were randomly assigned to usual care (n=10) or to an intervention group (n=10) that received 1 of 4 tailored messages to prepare them for withdrawal of life support. They were contacted 2 to 4 weeks later to complete the Profile of Mood States and to give their evaluation of the experience, inclusive of the information received. Results Compared with the usual-care group, the intervention group was significantly more satisfied with the information they received and understood better what was to happen. The intervention group had lower negative mood scores and higher positive mood scores than did the usual-care group, although the difference was not significant. Unsolicited comments by the usual-care participants were requests for the specific information that had been received by the intervention group. Conclusions The information provided was considered helpful. A larger sample might yield more significant differences. Further work is needed on other aspects of preparation such as healthcare support, spiritual issues, and preparation for funeral arrangements.

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Effectiveness of a School‐Based Educational Intervention to Improve Hypertension Control Among Schoolteachers: A Cluster‐Randomized Controlled Trial

Journal of the American Heart Association ◽

10.1161/jaha.121.023145 ◽

2022 ◽

Author(s):

G. K. Mini ◽

Thirunavukkarasu Sathish ◽

Prabhakaran Sankara Sarma ◽

Kavumpurathu Raman Thankappan

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Usual Care ◽

Educational Intervention ◽

Usual Care Group ◽

Controlled Trial ◽

Intervention Group ◽

Care Group ◽

Hypertension Control ◽

Antihypertensive Medications

Background The control of hypertension is low in low‐ and middle‐income countries like India. We evaluated the effects of a nurse‐facilitated educational intervention in improving the control rate of hypertension among school teachers in India. Methods and Results This was a cluster‐randomized controlled trial involving 92 schools in Kerala, which were randomly assigned equally into a usual care group and an intervention group. Participants were 402 school teachers (mean age, 47 years; men, 29%) identified with hypertension. Participants in both study groups received a leaflet containing details of a healthy lifestyle and the importance of regular intake of antihypertensive medication. In addition, the intervention participants received a nurse‐facilitated educational intervention on hypertension control for 3 months. The primary outcome was hypertension control. Key secondary outcomes included systolic blood pressure, diastolic blood pressure, and the proportion of participants taking antihypertensive medications. For the primary outcome, we used mixed‐effects logistic regression models. Two months after a 3‐month educational intervention, a greater proportion of intervention participants (49.0%) achieved hypertension control than the usual care participants (38.2%), with an odds ratio of 1.89 (95% CI, 1.06–3.35), after adjusting for baseline hypertension control. The odds of taking antihypertensive medications were 1.6 times higher in the intervention group compared with the usual care group (odds ratio, 1.62; 95% CI, 1.08–2.45). The reduction in mean systolic blood pressure was significantly greater in the intervention group by 4.2 mm Hg (95% CI, −7.2 to −1.1) than in the usual care group. Conclusions A nurse‐facilitated educational intervention was effective in improving the control and treatment rates of hypertension as well as reducing systolic blood pressure among schoolteachers with hypertension. Registration URL: https://www.ctri.nic.in ; Unique Identifier: CTRI/2018/01/011402.

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