scholarly journals Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1105
Author(s):  
Jonathan N. Tobin ◽  
Suzanne Hower ◽  
Brianna M. D’Orazio ◽  
María Pardos de la Gándara ◽  
Teresa H. Evering ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Reported Outcomes ◽  
Health Workers ◽  
Home Visits ◽  
Self Report ◽  
Household Member ◽  
Surveillance Culture ◽  
Home Based ◽  
Patient Reported ◽  
Household Members

Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.

scholarly journals Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

2020 ◽  
Author(s):  
Jonathan N. Tobin ◽  
Suzanne Hower ◽  
Brianna M. D’Orazio ◽  
María Pardos de la Gándara ◽  
Teresa H. Evering ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Health Workers ◽  
Home Visits ◽  
Self Report ◽  
Household Member ◽  
Surveillance Culture ◽  
Home Based ◽  
Patient Reported ◽  
Household Members ◽  
Data Surveillance

BACKGROUNDRecurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges.OBJECTIVESCan an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) reduce SSTI recurrence, mitigate household contamination and transmission, and improve patient-reported outcomes?DESIGNRandomized trialSETTINGCommunity settingsPARTICIPANTSParticipants (n=186) with confirmed MRSA(+)/MSSA(+) SSTIs and household members.INTERVENTIONCommunity Health Workers/Promotoras conducted home visits and provided participants with instructions, a five-day supply of mupirocin for nasal application, chlorhexidine for body cleansing, and disinfecting wipes for household cleaning (EXP) versus Usual Care (UC).MEASUREMENTSPrimary outcome was six-month SSTI recurrence recorded in electronic health records (EHR). Home visits (months 0/3) and telephone assessments (months 0/1/6) collected self-report data. Surveillance culture swabs (nares, axilla, groin) were obtained from index patients and participating household members. Secondary outcomes included household surface contamination, household member colonization and transmission, quality of life and satisfaction with care.RESULTSAmong patients with SSTIs (n=421), 44.2% were MRSA(+)/MSSA(+); an intent-to-treat analyses (n=186) demonstrated no significant differences in SSTI recurrence (OR: 1.4, 95% CI: 0.51-3.5). Among the enrolled cohort (n=119), there were no significant SSTI recurrence effects (OR=1.14, 95% CI=0.35-3.6). EXP participants showed reduced but non-significant colonization rates. There were no differential reductions in household member transmission or in reductions in proportions of households with ≥1 contaminated surface. Mupirocin resistance did not increase. No significant improvements for patient-reported outcomes were seen.LIMITATIONSA lower-than-predicted six-month recurrence rate may have limited the ability to detect effects.CONCLUSIONThis intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. No differences were observed for household members decolonization or household surfaces decontamination.

scholarly journals Engagement and Participant Experiences With Consumer Smartwatches for Health Research: Longitudinal, Observational Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Anna L Beukenhorst ◽  
Kelly Howells ◽  
Louise Cook ◽  
John McBeth ◽  
Terence W O'Neill ◽  
...  
Keyword(s):  
Data Collection ◽  
Knee Osteoarthritis ◽  
Patient Reported Outcomes ◽  
Health Data ◽  
Self Report ◽  
Sensor Data ◽  
Battery Life ◽  
Activity Data ◽  
Technical Problems ◽  
Patient Reported

BACKGROUND Wearables provide opportunities for frequent health data collection and symptom monitoring. The feasibility of using consumer cellular smartwatches to provide information both on symptoms and contemporary sensor data has not yet been investigated. OBJECTIVE This study aimed to investigate the feasibility and acceptability of using cellular smartwatches to capture multiple patient-reported outcomes per day alongside continuous physical activity data over a 3-month period in people living with knee osteoarthritis (OA). METHODS For the KOALAP (Knee OsteoArthritis: Linking Activity and Pain) study, a novel cellular smartwatch app for health data collection was developed. Participants (age ≥50 years; self-diagnosed knee OA) received a smartwatch (Huawei Watch 2) with the KOALAP app. When worn, the watch collected sensor data and prompted participants to self-report outcomes multiple times per day. Participants were invited for a baseline and follow-up interview to discuss their motivations and experiences. Engagement with the watch was measured using daily watch wear time and the percentage completion of watch questions. Interview transcripts were analyzed using grounded thematic analysis. RESULTS A total of 26 people participated in the study. Good use and engagement were observed over 3 months: most participants wore the watch on 75% (68/90) of days or more, for a median of 11 hours. The number of active participants declined over the study duration, especially in the final week. Among participants who remained active, neither watch time nor question completion percentage declined over time. Participants were mainly motivated to learn about their symptoms and enjoyed the self-tracking aspects of the watch. Barriers to full engagement were battery life limitations, technical problems, and unfulfilled expectations of the watch. Participants reported that they would have liked to report symptoms more than 4 or 5 times per day. CONCLUSIONS This study shows that capture of patient-reported outcomes multiple times per day with linked sensor data from a smartwatch is feasible over at least a 3-month period. INTERNATIONAL REGISTERED REPORT RR2-10.2196/10238

scholarly journals Exploring patient-reported outcomes of home-based cardiac rehabilitation in relation to Scottish, UK and European guidelines: an audit using qualitative methods

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024499 ◽  
Author(s):  
Hannah Ranaldi ◽  
Carolyn Deighan ◽  
Louise Taylor
Keyword(s):  
Cardiac Rehabilitation ◽  
Patient Reported Outcomes ◽  
Psychosocial Support ◽  
Daily Lives ◽  
Medical Risk ◽  
European Guidelines ◽  
Home Based ◽  
Patient Reported ◽  
The Uk ◽  
The Impact

ObjectivesThe Heart Manual (HM) is the UK’s leading facilitated home-based cardiac rehabilitation (CR) programme for individuals recovering from myocardial infarction and revascularisation. This audit explored patient-reported outcomes of home-based CR in relation to current Scottish, UK and European guidelines.SettingPatients across the UK returned their questionnaire after completing the HM programme to the HM Department (NHS Lothian).ParticipantsQualitative data from 457 questionnaires returned between 2011 and 2018 were included for thematic analysis. Seven themes were identified from the guidelines. This guided initial deductive coding and provided the basis for inductive subthemes to emerge.ResultsThemes included: (1) health behaviour change and modifiable risk reduction, (2) psychosocial support, (3) education, (4) social support, (5) medical risk management, (6) vocational rehabilitation and (7) long-term strategies and maintenance. Both (1) and (2) were reported as having the greatest impact on patients' daily lives. Subthemes for (1) included: guidance, engagement, awareness, consequences, attitude, no change and motivation. Psychosocial support comprised: stress management, pacing, relaxation, increased self-efficacy, validation, mental health and self-perception. This was followed by (3) and (4). Patients less frequently referred to (5), (6) and (7). Additional themes highlighted the impact of the HM programme and that patients attributed the greatest impact to a combination of all the above themes.ConclusionsThis audit highlighted the HM as comprehensive and inclusive of key elements proposed by Scottish, UK and EU guidelines. Patients reported this had a profound impact on their daily lives and proved advantageous for CR.

Breast cancer patient reported outcomes, depression, and objective measures of breast cosmesis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 569-569
Author(s):  
Shauna McManus ◽  
Jolinta Y Lin ◽  
Manali A. Bhave ◽  
Gabrielle Brown ◽  
India Green ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Patient Reported Outcomes ◽  
Depressive Symptomatology ◽  
Cosmetic Outcome ◽  
Self Report ◽  
Objective Measures ◽  
Breast Asymmetry ◽  
Patient Reported ◽  
Prospective Longitudinal ◽  
The Relationship

569 Background: Patient-reported outcomes (PROs) of cosmesis after breast-conserving therapy (BCT) are increasingly emphasized as meaningful treatment endpoints but little is known about the relationship between objective measures, mood, and PROs following radiation (XRT). We hypothesized that pre-XRT depression, assessed by Inventory of Depressive Symptomatology Self-Report (IDS-SR), would influence PROs of breast cosmesis 1-year post-XRT independent of objective measures of breast asymmetry. Methods: 98 women were enrolled on two prospective longitudinal studies of breast cosmesis. Percentage breast retraction assessment (pBRA) was used as an objective measure of breast asymmetry pre- and 1 year post-XRT. At the same time points, pBRA was measured and compared with two different PRO ratings of cosmetic outcome (0-10 scale): 1) happiness with cosmesis and 2) perceived differences in treated vs. untreated breast. We performed univariate and multivariate analysis to evaluate the relationship between PROs, pBRA, IDS-SR scores, clinical, tumor, and treatment characteristics. Results: Among subjects, 50% were African American. Mean age was 56.45 years. At 1 year, 65.3% of patients were happy with their cosmetic outcome (Score > 8) although 59.5% noted moderate to severe differences in the treated vs. untreated breast (Score < 6). Mean pBRA increased from 7.20 (SD 3.88) pre-XRT to 9.69 (SD 6.22) confirming more breast asymmetry 1-year post-XRT. Prior to XRT, 23% of patients had moderate-to-severe depression (IDS-SR scores > 26). In multivariate analyses, 1 year PROs of happiness with cosmetic outcome did not correlate with pBRA (p = 0.3) but were strongly correlated with pre and post-XRT depression (all p < 0.05). Patients were more likely to perceive differences in breast texture or asymmetry (i.e. lower PRO ratings of asymmetry) if they had higher pBRA measurements at 1 year (all p = 0.004). Neither pre- nor post- XRT depression were associated with specific PRO ratings of breast asymmetry in multivariate analysis. Conclusions: Our study suggests that PROs may not always reflect the effects of cancer treatment. For patients treated with BCT, baseline depression strongly influenced patient reported happiness with overall cosmetic outcome 1 year post-XRT. Perceived differences in the treated vs. untreated breast correlated with objective measures of breast asymmetry. Our data suggests that this PRO may be more indicative of treatment-related toxicities than patient ratings of overall satisfaction and happiness with cosmetic outcome. Clinical trial information: NCT03167359 .

scholarly journals A Prospective Randomized Controlled Trial Comparing Physical Therapy with Independent Home Stretching for Plantar Fasciitis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Philip B. Kaiser ◽  
Alexander M. Crawford ◽  
Eric M. Bluman ◽  
Jeremy T. Smith ◽  
Christopher P. Chiodo
Keyword(s):  
Patient Reported Outcomes ◽  
Controlled Trial ◽  
Plantar Fascia ◽  
Intergroup Difference ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Home Based ◽  
Sf 36 ◽  
Prospective Randomized Controlled Trial ◽  
Patient Reported

Category: Hindfoot, Heel pain, plantar fascia Introduction/Purpose: Physical therapy (PT) is an effective treatment modality for patients with plantar fasciitis (PF) however it is unclear how this compares to a home-based plantar fascia-stretching (HS) protocol. We hypothesized there would be no difference in pain scores or clinical outcomes in patients treated with formal PT compared to those who performed HS. Methods: Fifty-seven patients with PF for at least three months were enrolled in a prospective randomized controlled trial comparing formal PT, using any and all modalities deemed clinically necessary, to a standardized HS protocol. Pain scores using a visual analog scale (VAS) and clinical patient reported outcomes including the Foot and Ankle Ability Measures (FAAM) and the Short Form (36) Health Survey (SF-36) were recorded and analyzed at 6 weeks, 3 months, 6 months, and 1 year after treatment commenced. Results: There were no significant differences in pain scores (VAS) or patient reported outcomes (FAAM and SF-36) at any follow-up time point between patient groups. At 6-months pain scores had improved in both the HS group (35% decrease, p<0.001) and PT group (26% decrease, p=0.002) relative to baseline without a significant intergroup difference (p=0.32). FAAM- activities of daily living (ADL) scores improved 13.0% (p=0.005) in the HS group and 21.3% (p<0.001) in the PT group at 6-months relative to baseline without a significant intergroup difference (p=0.84). The Physical Component Summary (PCS) Scores of the SF- 36 demonstrated improvement at the six week, three month, and one year time points in both groups. Conclusion: A home-based stretching therapy program demonstrated equivalent improvements in pain scores and clinical outcomes compared to formal PT in the treatment of PF. Most patients with PF who perform daily plantar fascia stretching exercises can expect substantial durable clinical improvement in their symptoms.

scholarly journals Telerehabilitation in Multiple Sclerosis: Results of a Randomized Feasibility and Efficacy Pilot Study

2018 ◽  
Vol 10 (2) ◽  
pp. 55-64 ◽  
Author(s):  
Cecilie Fjeldstad-Pardo ◽  
Amy Thiessen ◽  
Gabriel Pardo
Keyword(s):  
Multiple Sclerosis ◽  
Patient Reported Outcomes ◽  
Exercise Program ◽  
Comparable Efficacy ◽  
Home Based ◽  
Included Patient ◽  
Patient Reported ◽  
Group 2 ◽  
Objective Outcomes ◽  
Functional Gait

A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Thirty participants were evaluated at baseline and randomized to one of three groups with intervention lasting 8 weeks: Group 1 (control)- customized unsupervised home-based exercise program (HEP) 5 days a week; Group 2 (TR)- remote PT supervised via audio/visual real-time telecommunication twice weekly; Group 3 (PT)- in-person PT at the medical facility twice weekly. Outcomes included patient reported outcomes (PROs) obtained through questionnaires, and measurements of gait and balance performed with bedside tests and a computerized system. Functional gait assessment improved from baseline in all three groups. There were no significant differences between the TR and the conventional PT groups for a variety of outcome measures. TR is a feasible method to perform PT in persons with MS and has comparable efficacy to conventional in-person PT as measured by patient reported outcomes and objective outcomes of gait and balance.

scholarly journals Cross-cultural adaptation to Portuguese of a measure of satisfaction with participation of the Patient-Reported Outcomes Measurement Information System (PROMIS(r))

2015 ◽  
Vol 37 (2) ◽  
pp. 94-99
Author(s):  
Maria Cristina Lima e Silva ◽  
Tânia Maria da Silva Mendonça ◽  
Carlos Henrique Martins da Silva ◽  
Rogério de Melo Costa Pinto
Keyword(s):  
Information System ◽  
Cultural Adaptation ◽  
Patient Reported Outcomes ◽  
Item Bank ◽  
Self Report ◽  
Measurement Information ◽  
Outcomes Measurement ◽  
Patient Reported ◽  
Measurement Information System ◽  
The Impact

Background: Mental disorders often impair functioning in several areas of life and lead to unhappiness and suffering that may affect health-related quality of life (HRQoL). Satisfaction with participation is an indicator of HRQoL, and its measurement by patients reflects the impact of disease on their social, emotional and professional life. The Patient-Reported Outcomes Measurement Information System (PROMIS(r)) offers an item bank based on item response theory. This system provides efficient, reliable and valid self-report instruments of satisfaction with participation, a measure that is both scarce and useful in the assessment of mental disorder outcomes.Objective:To cross-culturally adapt the PROMIS(r) satisfaction with participation item bank to Portuguese.Methods:Cross-cultural adaptation followed the Functional Assessment of Chronic Illness Therapy (FACIT) multilingual translation method and was achieved through steps of forward and backward translations, review by bilingual experts (one of them a native of Portugal) and pretesting in a group of 11 adult native Brazilians. Instrument adaptation followed a universal approach to translation, with harmonization across languages.Results: Equivalence of meaning was achieved. As two of the 26 translated items, which asked about leisure and social activities, were not understood by less educated participants, an explanation in parentheses was added to each item, and the problem was solved. All items were appropriate and did not cause embarrassment to the participants.Conclusions: The satisfaction with participation item bank is culturally and linguistically suitable to be used in Brazil. After the pretest is applied in Portugal and in other Portuguese-speaking countries, the same instrument will be ready to be used in multinational studies.

Abstract P479: Feasibility Study to Compare Heart Failure Risk Prediction Tools in the Emergency Department

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Andrew Scott ◽  
Kevin Chronowski ◽  
Snigdha Peddireddy ◽  
Sarah Fatima ◽  
Bailey DeBarmore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Prediction ◽  
Patient Reported Outcomes ◽  
Missing Values ◽  
Complete Data ◽  
Self Report ◽  
Convenience Sample ◽  
Walking Test ◽  
Prediction Tools ◽  
Patient Reported

Background: In United States (US) emergency departments (ED), ~80% of patients presenting with exacerbation of heart failure (HF) symptoms are admitted to the hospital. However, some patients are at low-risk of adverse outcomes and might be effectively managed as outpatients. While ED HF risk prediction tools guide admission or discharge decisions, they have not been compared, are not routinely used in EDs, and do not include patient-reported outcomes that may be associated with prognosis. Objective: To assess the feasibility of collecting variables for three published ED-based HF risk prediction tools (table) and the capacity to collect participant-reported outcomes. Methods: We screened a convenience sample of patients age ≥20 years with symptoms of HF (e.g. shortness of breath, edema) receiving care in a US ED. We collected information from medical records, and administered a questionnaire to collect patient-reported outcomes and a 3-minute walking test. We developed a safety protocol to identify participants ineligible for the walking test. Results: We screened 66 patients and consented 31 (47%) participants. The average age was 61 years, 6 (19.4%) were female and 28 (90.3%) were admitted. We completed all the questionnaires with an average time of 31 minutes. For the walking test, 15 were ineligible per the safety protocol, 6 completed the test, and 10 did not consent. For the three HF tools, we collected an average of 93.4% of the variables needed per participant (range across tools 91.4%-97.7%; Table). The main missing variables were BMI on ED arrival (n=23) and troponin (due to hemolyzed values, n=5). Conclusion: We obtained complete data for the participant questionnaires, yet there were missing values for variables needed for the HF tools. The Emergency Heart Failure Mortality Risk Grade tool had the most complete data. If a research or clinical study plans to use these tools, the study protocol should include BMI and troponin measurements and consider alternative strategies to collect data, such as by self-report.

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