Use of an Educational Multimedia Tool Versus Routine Care for the Uptake of Postpartum LARC in High-Risk Pregnancies

2020 ◽  
Author(s):  
Keyword(s):  
High Risk ◽  
Routine Care ◽  
Educational Multimedia ◽  
Multimedia Tool

In-Hospital Mortality and Related Outcomes for Elevated Risk Acute Pulmonary Embolism Treated With Mechanical Thrombectomy Versus Routine Care

2021 ◽  
pp. 088506662110364
Author(s):  
Jennifer R. Buckley ◽  
Brandt C. Wible
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Routine Care ◽  
Hospital Length ◽  
Elevated Risk ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay

Purpose To compare in-hospital mortality and other hospitalization related outcomes of elevated risk patients (Pulmonary Embolism Severity Index [PESI] score of 4 or 5, and, European Society of Cardiology [ESC] classification of intermediate-high or high risk) with acute central pulmonary embolism (PE) treated with mechanical thrombectomy (MT) using the Inari FlowTriever device versus those treated with routine care (RC). Materials and Methods Retrospective data was collected of all patients with acute, central PE treated at a single institution over 2 concurrent 18-month periods. All collected patients were risk stratified using the PESI and ESC Guidelines. The comparison was made between patients with acute PE with PESI scores of 4 or 5, and, ESC classification of intermediate-high or high risk based on treatment type: MT and RC. The primary endpoint evaluated was in-hospital mortality. Secondary endpoints included intensive care unit (ICU) length of stay, total hospital length of stay, and 30-day readmission. Results Fifty-eight patients met inclusion criteria, 28 in the MT group and 30 in the RC group. Most RC patients were treated with systemic anticoagulation alone (24 of 30). In-hospital mortality was significantly lower for the MT group than for the RC group (3.6% vs 23.3%, P < .05), as was the average ICU length of stay (2.1 ± 1.2 vs 6.1 ± 8.6 days, P < .05). Total hospital length of stay and 30-day readmission rates were similar between MT and RC groups. Conclusion Initial retrospective comparison suggests MT can improve in-hospital mortality and decrease ICU length of stay for patients with acute, central PE of elevated risk (PESI 4 or 5, and, ESC intermediate-high or high risk).

scholarly journals Accelerometery as a measure of modifiable physical activity in high-risk elderly preoperative patients: a prospective observational pilot study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032346 ◽  
Author(s):  
Lisa Grimes ◽  
Joanne G Outtrim ◽  
Simon J Griffin ◽  
Ari Ercole
Keyword(s):  
Physical Activity ◽  
Pilot Study ◽  
High Risk ◽  
Behavioural Change ◽  
The Elderly ◽  
Routine Care ◽  
Major Surgery ◽  
Post Intervention ◽  
Wear Time ◽  
Patient Reported

ObjectivesTo use wrist-worn accelerometers (Axivity AX3) to establish normative physical activity (PA) and acceptability data for the high-risk elderly preoperative population, to assess whether PA could be modified by a prehabilitation intervention as part of routine care, to assess any correlation between accelerometer-measured PA and self-reported PA and to assess the acceptability of wearing wrist-worn accelerometers in this population.Study designProspective, observational, pilot study.SettingSingle National Health Service Hospital.ParticipantsFrail patients≥65 years awaiting major surgery referred to a multidisciplinary preoperative clinic at which they received a routine intervention aimed at improving their PA. 35 patients were recruited. Average age 79.9 years (SD=5.6).Primary outcomesNormative PA data measured as a mean daily Euclidean norm minus one (ENMO) in milli-gravitational units (mg).Secondary outcomesMeasure PA levels (mg) following a routine preoperative intervention. Determine correlation between patient-reported PA (measured using the Physical Activity Scale for the Elderly) and accelerometer-measured PA (mg). Assess acceptability of wearing a wrist-worn accelerometer measured using Visual Analogue Scale (VAS) questionnaire and device wear time (hours).ResultsMedian baseline daily PA was 14.3 mg(IQR 9.75–22.04) with an improvement in PA detected following the intervention (median ENMO post intervention 20.91 mg(IQR 14.83–27.53), p=0.022). There was no significant correlation between accelerometer-measured and self-reported PA (baselineρ=0.162 (p=0.4), post interventionρ=−0.144 (p=0.5)). We found high acceptability ratings (median score of 10/10 on VAS, IQR 8–10) and wear-time compliance (163.2 hours (IQR 150–167.5) preintervention and 166.1 hours (IQR 162.5–167) post intervention).ConclusionsAccelerometery is acceptable to this population and increases in PA levels measured following an unoptimised routine clinical intervention which indicates that health behavioural change interventions may be successful during the preoperative period. Accelerometers may therefore be a useful tool to design and validate interventions for improving PA in this setting.Trial registration numberNCT03737903.

scholarly journals Effect of Inspiratory Muscle Training Before Cardiac Surgery in Routine Care

2013 ◽  
Vol 93 (5) ◽  
pp. 611-619 ◽  
Author(s):  
Karin Valkenet ◽  
Frederiek de Heer ◽  
Frank J.G. Backx ◽  
Jaap C.A. Trappenburg ◽  
Erik H.J. Hulzebos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Length Of Stay ◽  
Routine Care ◽  
Inspiratory Muscle ◽  
Postoperative Pneumonia ◽  
Muscle Training ◽  
Propensity Scoring ◽  
Group 2 ◽  
Group 1

BackgroundInspiratory muscle training (IMT) before cardiac surgery has proved to be a promising intervention to reduce postoperative pneumonia in a randomized controlled trial setting. Effects of IMT in routine care have not been reported.ObjectiveThe purpose of this study was to investigate the effect of IMT before cardiac surgery on postoperative pneumonia in routine care at a Dutch university medical center using propensity scoring.DesignThis was an observational cohort study.MethodsAll candidates for cardiac surgery were preoperatively stratified by a physical therapist for low risk or high risk for postoperative pulmonary complications. Patients at high risk either engaged in an unsupervised IMT program (20 minutes a day) at home for at least 2 weeks before surgery (group 1) or received usual care (no IMT) (group 2). Results in terms of outcome measures were adjusted with propensity scores to reduce bias caused by nonrandom treatment assignment.ResultsThe results showed that of the 94 patients at high risk in group 1, 1 patient (1.1%) developed a postoperative pneumonia. In group 2, 8 out of the 252 patients at high risk (3.2%) developed this pulmonary complication (adjusted odds ratio=0.34, 95% confidence interval=0.04–3.38). No significant differences were found regarding median (25th–75th percentile) ventilation time (7 [5–9] hours versus 7 [5–10] hours), length of stay in the intensive care unit (23 [21–24] hours versus 23 [21–25] hours), or total postoperative length of stay (7 [6–11] days versus 7 [5–9] days).LimitationsThe most important limitations of this study were confounding, incomplete data collection, and a low incidence of the primary outcome.ConclusionsPropensity scoring is believed to be a valuable tool of great potential interest to researchers in the field of observational studies. Whether IMT in routine care resulted in less postoperative pneumonia cannot be concluded.

scholarly journals Effects of cosmetic and other camouflage interventions on appearance-related and psychological outcomes among adults with visible differences in appearance: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046634
Author(s):  
Shadi Gholizadeh ◽  
Danielle B Rice ◽  
Andrea Carboni-Jiménez ◽  
Linda Kwakkenbos ◽  
Jill Boruff ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Adverse Effects ◽  
Data Extraction ◽  
Routine Care ◽  
Psychological Outcomes ◽  
Risk Of Bias ◽  
Eligibility Criteria ◽  
Randomised Controlled ◽  
Poor Reporting

ObjectiveVisible differences in appearance are associated with poor social and psychological outcomes. Effectiveness of non-surgical cosmetic and other camouflage interventions is poorly understood. The objective was to evaluate effects of cosmetic and other camouflage interventions on appearance-related outcomes, general psychological outcomes and adverse effects for adults with visible appearance differences.DesignSystematic review.Data sourcesMEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid) CINAHL and Cochrane Central databases searched from inception to 24 October 2020. Two reviewers independently reviewed titles and abstracts and full texts.Eligibility criteriaRandomised controlled trials in any language on non-surgical cosmetic or other camouflage interventions that reported appearance-related outcomes, general psychological outcomes or adverse effects for adults with visible appearance differences.Data extraction and synthesisTwo reviewers independently extracted data, assessed intervention reporting using the Template for Intervention Description and Replication checklist, and assessed risk of bias using the Cochrane risk of bias tool. Outcomes included appearance-related outcomes, general psychological outcomes (eg, depression, anxiety) and adverse effects.ResultsOne head-to-head trial and five trials with waiting list or routine care comparators were included. All had unclear or high risk of bias in at least five of seven domains. Effect sizes could not be determined for most outcomes due to poor reporting. Between-group statistically significant differences were not reported for any appearance-related outcomes and for only 5 of 25 (20%) other psychological outcomes. Given heterogeneity of populations and interventions, poor reporting and high risk of bias, quantitative synthesis was not possible.ConclusionsConclusions about effectiveness of non-surgical cosmetic or other camouflage interventions could not be drawn. Well-designed and conducted trials are needed. Without such evidence, clinicians or other qualified individuals should engage with patients interested in cosmetic interventions in shared decision making, outlining potential benefits and harms, and the lack of evidence to inform decisions.PROSPERO registration numberCRD42018103421.

scholarly journals Postpartum LARC Uptake in High-Risk Pregnancies with Decision Aid versus Routine Care: A Randomized Trial

2022 ◽  
Vol 226 (1) ◽  
pp. S265-S266
Author(s):  
Emma J. Qureshey ◽  
Suneet P. Chauhan ◽  
Stephen M. Wagner ◽  
Oliver Batiste ◽  
Han-Yang Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Trial ◽  
Decision Aid ◽  
Routine Care

Validation of an Automated Surveillance Approach for Drain-Related Meningitis: A Multicenter Study

2015 ◽  
Vol 36 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Maaike S. M. van Mourik ◽  
Annet Troelstra ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
Marischka C. E. van der Jagt-Zwetsloot ◽  
Jolande H. Nelson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
High Risk ◽  
Prediction Model ◽  
Chart Review ◽  
Routine Care ◽  
High Risk Patients ◽  
Neurosurgical Patients ◽  
Risk Patients ◽  
Automated Surveillance ◽  
Healthcare Associated

OBJECTIVEManual surveillance of healthcare-associated infections is cumbersome and vulnerable to subjective interpretation. Automated systems are under development to improve efficiency and reliability of surveillance, for example by selecting high-risk patients requiring manual chart review. In this study, we aimed to validate a previously developed multivariable prediction modeling approach for detecting drain-related meningitis (DRM) in neurosurgical patients and to assess its merits compared to conventional methods of automated surveillance.METHODSProspective cohort study in 3 hospitals assessing the accuracy and efficiency of 2 automated surveillance methods for detecting DRM, the multivariable prediction model and a classification algorithm, using manual chart review as the reference standard. All 3 methods of surveillance were performed independently. Patients receiving cerebrospinal fluid drains were included (2012–2013), except children, and patients deceased within 24 hours or with pre-existing meningitis. Data required by automated surveillance methods were extracted from routine care clinical data warehouses.RESULTSIn total, DRM occurred in 37 of 366 external cerebrospinal fluid drainage episodes (12.3/1000 drain days at risk). The multivariable prediction model had good discriminatory power (area under the ROC curve 0.91–1.00 by hospital), had adequate overall calibration, and could identify high-risk patients requiring manual confirmation with 97.3% sensitivity and 52.2% positive predictive value, decreasing the workload for manual surveillance by 81%. The multivariable approach was more efficient than classification algorithms in 2 of 3 hospitals.CONCLUSIONSAutomated surveillance of DRM using a multivariable prediction model in multiple hospitals considerably reduced the burden for manual chart review at near-perfect sensitivity.Infect Control Hosp Epidemiol 2015;36(1): 65–75

scholarly journals Rivaroxaban for Preventing Venous Thromboembolism in High-Risk Ambulatory Patients with Cancer: Rationale and Design of the CASSINI Trial

2017 ◽  
Vol 117 (11) ◽  
pp. 2135-2145 ◽  
Author(s):  
Alok Khorana ◽  
Saroj Vadhan-Raj ◽  
Nicole Kuderer ◽  
Ted Wun ◽  
Howard Liebman ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Factor Xa ◽  
Routine Care ◽  
Bleeding Events ◽  
Double Blind ◽  
Primary Brain Tumours ◽  
Incidental Pulmonary Embolism ◽  
Increased Risk ◽  
Ambulatory Patients

AbstractVenous thromboembolism (VTE) is a frequent complication of cancer associated with morbidity, mortality, increased hospitalizations and higher health care costs. Cancer patients at increased risk for VTE can be identified using a validated risk assessment score, and the incidence of VTE can be reduced in high-risk settings using anticoagulation. Rivaroxaban is a potent, oral, direct, factor Xa inhibitor approved for the prevention and treatment of thromboembolic events, including VTE. CASSINI is a double-blind, randomized, parallel-group, multicentre study comparing rivaroxaban with placebo in adult ambulatory patients with various cancers who are initiating systemic cancer therapy and are at high risk of VTE (Khorana score ≥ 2). Patients with primary brain tumours or those at risk for bleeding are excluded. Approximately 700 patients will be randomized 1:1 to rivaroxaban 10 mg daily or placebo for up to 6 months if there is no evidence of VTE from compression ultrasonography (CU) during screening or from routine care imaging within 30 days prior to randomization. Mandatory CU will also be performed at weeks 8 and 16 (±7 days), and at study end (±3 days). The primary efficacy hypothesis is that anticoagulation with rivaroxaban reduces the composite of objectively confirmed symptomatic or asymptomatic, lower-extremity, proximal deep-vein thrombosis (DVT); symptomatic, upper-extremity DVT; symptomatic or incidental pulmonary embolism; and VTE-related death compared with placebo. The primary safety objective is to assess major bleeding events (Clinical trial information: NCT02555878).

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