The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia

Severe dysphagia leads to mortality in older patients and hinders their discharge from hospitals. The temporal flat lateral position (TFLP) enables them to continuously eat, thus resolving the aforementioned issues. We aimed to explore the effect of TFLP on the mortality and discharge rates of older patients with severe dysphagia. This interventional study comprised a historical control of patients admitted to a rural community hospital from January 2019 to December 2020 and diagnosed with severe dysphagia. The primary outcomes included the mortality and the rate of discharge from the hospital. While the intervention group was treated with TFLP, the control group underwent no treatment. We selected 79 participants (intervention group = 26, control group = 53), with an average age of 87.9 years. The discharge rate was significantly higher in the intervention group than in the control group (57.7% vs. 26.4%, p = 0.012). The mortality rate was also significantly lower in the intervention group compared to the control group (34.6% vs. 71.7%, p = 0.003). TFLP can improve the discharge and mortality rates in community hospitals, thereby improving patient outcomes. Clinicians should focus on practical education and the implementation of TFLP in communities in order to promote it.

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Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-037999 ◽

2021 ◽

Vol 11 (2) ◽

pp. e037999

Author(s):

Martina Rimmele ◽

Jenny Wirth ◽

Sabine Britting ◽

Thomas Gehr ◽

Margit Hermann ◽

...

Keyword(s):

Older Patients ◽

Transitional Care ◽

Intervention Group ◽

Care Quality ◽

Care Plan ◽

Control Group ◽

Care Services ◽

Continuous Care ◽

Hospital To Home ◽

Randomised Controlled

IntroductionIn Germany, an efficient and feasible transition from hospital to home for older patients, ensuring continuous care across healthcare settings, has not yet been applied and evaluated. Based on the transitional care model (TCM), this study aims to reduce preventable readmissions of patients ≥75 years of age with a transitional care intervention performed by geriatric-experienced care professionals. The study investigates whether the intervention ensures continuous care during transition and stabilises the care situation of patients at home.Methods and analysesRandomised controlled clinical trial, recruiting between 25 April 2018 and 31 December 2019 in one German hospital in the city of Regensburg. The intervention group is supported by care professionals in the transition process from hospital to home for up to 12 months. Based on TCM, the intervention includes an individual care plan according to a patient’s symptoms, risks, needs and values. The plan is advanced in the domestic situation via personal visits and telephone contacts. All necessary care actions regarding, for example, mobility, residence adjustments, or nutrition, are initiated to be executed by ambulant care services, and are monitored, evaluated and adapted if necessary. In supervising the care plan, the care professionals do not administer active care services themselves but coordinate them. Patients and their caregivers are actively engaged in the care planning and execution. In contrast, the control group receives only usual discharge planning in the hospital and usual ambulatory care.The primary outcome is the all-cause readmission rate assessed using health insurance data within a follow-up of up to 12 months after hospital discharge. Secondary outcomes include care quality, mobility, nutritional and wound situation, and health-related quality of life. They are assessed at baseline, after 1 month, 3 months, 6 months, and at the end of study visit. Additionally, the economic efficiency of the intervention will be evaluated.Ethics and disseminationEthics approval for the trial was obtained from the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg. Results will be published in peer-reviewed, open-access scientific journals and disseminated at national and international research conferences and through public presentations in the geriatric and healthcare community.Trial registrationClinicalTrials.gov identifier: NCT03513159.

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Impact of a pharmacy team–led intervention program on the readmission rate of elderly patients with heart failure

American Journal of Health-System Pharmacy ◽

10.2146/ajhp170256 ◽

2018 ◽

Vol 75 (4) ◽

pp. 183-190 ◽

Cited By ~ 9

Author(s):

Pamela M. Moye ◽

Pui Shan Chu ◽

Teresa Pounds ◽

Maria Miller Thurston

Keyword(s):

Heart Failure ◽

Older Patients ◽

Readmission Rate ◽

Academic Medical Center ◽

Hospital Readmissions ◽

Intervention Group ◽

Historical Control Group ◽

Historical Control ◽

Control Group ◽

Patients With Heart Failure

Purpose The results of a study to determine whether pharmacy team–led postdischarge intervention can reduce the rate of 30-day hospital readmissions in older patients with heart failure (HF) are reported. Methods A retrospective chart review was performed to identify patients 60 years of age or older who were admitted to an academic medical center with a primary diagnosis of HF during the period March 2013–June 2014 and received standard postdischarge follow-up care provided by physicians, nurses, and case managers. The rate of 30-day readmissions in that historical control group was compared with the readmission rate in a group of older patients with HF who were admitted to the hospital during a 15-month intervention period (July 2014–October 2015); in addition to usual postdischarge care, these patients received medication reconciliation and counseling from a team of pharmacists, pharmacy residents, and pharmacy students. Results Twelve of 97 patients in the intervention group (12%) and 20 of 80 patients in the control group (25%) were readmitted to the hospital within 30 days of discharge (p = 0.03); 11 patients in the control group (55%) and 7 patients in the intervention group (58%) had HF-related readmissions (p = 0.85). Conclusion In a population of older patients with HF, the rate of 30-day all-cause readmissions in a group of patients targeted for a pharmacy team–led postdischarge intervention was significantly lower than the all-cause readmission rate in a historical control group.

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Effectiveness of mobile short messaging services to improve parent’s knowledge, attitude and practice on drowning prevention in Bangladesh (Preprint)

10.2196/preprints.27829 ◽

2021 ◽

Author(s):

Prof Dr Kulanthayan KC Mani ◽

Dr Md Mosharaf Hossain

Keyword(s):

Rural Community ◽

Intervention Group ◽

Developed Countries ◽

Control Group ◽

Drowning Prevention ◽

Under Five ◽

Time Interaction ◽

Sms Intervention ◽

Outcome Differences ◽

Cluster Randomized

BACKGROUND Drowning is the leading cause of death in children aged one year and over in Bangladesh. Drowning rates in Bangladesh are 10 to 20 times the rates of child drowning in developed countries. OBJECTIVE The aim of this to test the effectiveness of a mobile SMS intervention to improve the knowledge, attitude, and practices of parents of children aged under five concerning the prevention of drowning. METHODS Study Design: a cluster randomized community trial with 788 parents of children aged under five in a rural community of Bangladesh. Methods: Intervention: Mobile SMS intervention for parents of children under five years concerning the prevention of drowning. Outcome: differences in knowledge, attitude and practices of parents concerning the prevention of drowning between the baseline and immediate follow-up after the intervention, and after three months. RESULTS There was a significant improvement in knowledge in the intervention group compared to the control group at different time points [baseline: F(1, 787) = 0.33, ρ-value = 0.56; immediately after intervention: F(1, 772) = 2989.25, ρ-value = 0.001; 3-months after intervention F(1, 761) = 4591.33, ρ-value = 0.001]. Similarly, there was an improvement in the positive attitude and good practices of parents on prevention of drowning. There were significant main effect for group [F(1, 379) = 5084.81, ρ-value = 0.001], time [F(1, 379) = 5786.11, ρ-value = 0.001], and group and time interaction [F(1, 331) = 2425.33, ρ-value = 0.001] in terms of the drowning prevention knowledge of parents. Similarly, the main effects for group, time, and group and time interaction for drowning prevention attitude and drowning prevention practices of parents were also significant. CONCLUSIONS The mobile based SMS intervention developed was effective in improving the knowledge, attitude, and practices of parents of children aged under five concerning drowning prevention in a rural community of Bangladesh. CLINICALTRIAL ISRCTN13774693

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The Differences of Left Lateral and Head Elevation Position toward Heart Rate of Newborns with Asphyxia in the Perinatology Room RSUD Dr. Soediran Mangun Sumarso Wonogiri

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6192 ◽

2021 ◽

Vol 9 (B) ◽

pp. 492-496

Author(s):

Noerma Shovie Rizqiea ◽

Septy Nur Aini ◽

Ratih Dwilestari Puji Utami ◽

Ratnawati Ratnawati ◽

Khairunisa Wardani

Keyword(s):

Heart Rate ◽

Intervention Group ◽

Lateral Position ◽

T Test ◽

Control Group ◽

Test Analysis ◽

Left Lateral Position ◽

Head Elevation ◽

Significant Difference ◽

Paired T Test

BACKGROUND: Asphyxia delivery results in hypoxic-ischemic encephalopathy and multiorgan failure. The organ most affected by hypoxia is the cardiovascular system. Newborns with asphyxia have a lack of oxygen (hypoxia) and have an increased heart rate (tachycardia). Giving baby positions, such as supination position, pronation, right lateral, left lateral, and head elevation, are expected to improve the hemodynamic of newborns with asphyxia. AIM: This study was to determine the difference in effect between left lateral position and the head elevation position on the heart rate of newborns with asphyxia in the perinatology room of RSUD Dr. Soediran Mangun Sumarso Wonogiri. METHODS: This research is a quasi-experimental quantitative study with a pre- and post-test non-equivalent control group design. Sampling using non-probability sampling technique with consecutive sampling. The sample was divided into two groups, namely, the intervention group with 30 respondents who got the left lateral position and the control group with 30 respondents who got the head elevation position. Data analysis was performed using the Statistical Package for the Social Sciences parametric test with paired t-test and independent t-test. RESULTS: The results of paired t-test analysis in the intervention group obtained p = 0.003 (p < 0.05) and in the control group obtained p < 0.001 (p < 0.05), which means that both have a significantly on changes in the heart rate of newborns with asphyxia. The results of the independent t-test analysis obtained p = 0.191 (p < 0.05), which means that there is no significant difference in the heart rate of newborns with asphyxia in the intervention and control groups. CONCLUSION: Both interventions, giving the left lateral position and the head elevation position, have a significantly effect on changes in the heart rate of newborns with asphyxia.

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Better before–better after: efficacy of prehabilitation for older patients with osteoarthritis awaiting total hip replacement—a study protocol for a randomised controlled trial in South-Eastern Norway

BMJ Open ◽

10.1136/bmjopen-2019-031626 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031626 ◽

Cited By ~ 1

Author(s):

Odd-Einar Svinøy ◽

Astrid Bergland ◽

May Arna Risberg ◽

Are Hugo Pripp ◽

Gunvor Hilde

Keyword(s):

Randomised Controlled Trial ◽

Total Hip Replacement ◽

Hip Replacement ◽

Older Patients ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Total Hip ◽

Hospital Referral ◽

Randomised Controlled

IntroductionHealth professions need to prepare for the increase of older patients with osteoarthritis requiring health services including those requiring total joint arthroplasty (TJA). The primary objective of this study is to assess the effect of a tailored prehabilitation programme of older patients awaiting primary surgery for total hip replacement on physical function measured by walking speed within 1 week after intervention as well as 6 weeks and 3 months after TJA surgery.Methods and analysisThis is a single-blinded randomised controlled trial. The participants are 70 years or older, scheduled for primary total hip replacement due to late stage osteoarthritis. The intervention group will receive patient education and exercise for 6–12 weeks. The control group will receive care as usual. The primary outcome is gait speed. Secondary outcomes are lower body strength, mobility, aerobic capacity, activity of daily living, length of stay at the hospital, referral to an inpatient rehabilitation clinic, pain, quality of life and cost-effectiveness. Estimated sample size is 150 participants randomised into the two arms. The data will be analysed following the intention-to-treat principle with methods for repeated measurements.Ethics and disseminationThe project proposal has been approved by The Regional Committee for Medical Research Ethics in South Norway (ref no. 2018/503). The results will be published in peer-reviewed articles.Trial registration numberNCT03602105

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Does a 12-Month Transitional Care Model Intervention by Geriatric-Experienced Care Professionals Improve Nutritional Status of Older Patients after Hospital Discharge? A Randomized Controlled Trial

Nutrients ◽

10.3390/nu13093023 ◽

2021 ◽

Vol 13 (9) ◽

pp. 3023

Author(s):

Neshat Chareh ◽

Anja Rappl ◽

Martina Rimmele ◽

Klaus Wingenfeld ◽

Ellen Freiberger ◽

...

Keyword(s):

Nutritional Status ◽

Hospital Discharge ◽

Older Patients ◽

Short Form ◽

Intervention Group ◽

Mini Nutritional Assessment ◽

Control Group ◽

Living Situation ◽

Individualized Care ◽

Phone Calls

At hospital discharge, many older patients are at health and nutritional risk, indicating a requirement for ongoing care. We aim to evaluate the effects of comprehensive individualized care by geriatric-experienced care professionals, the so-called “pathfinders”, on nutritional status (NS) of older patients after discharge. A total of 244 patients (median age 81.0 years) without major cognitive impairment were randomized to Intervention Group (IG: 123) or Control Group (CG: 121) for a 12-month intervention, with up to 7 home visits and 11 phone calls. The comprehensive individualized care contained nutritional advice, when required. The intervention effect after three (T3m) and 12 (T12m) months on change in MNA-SF (Mini Nutritional Assessment-Short Form) and BMI was evaluated by Univariate General Linear Model (ANOVA), adjusted for age, sex, living situation, and activities of daily living. At baseline, mean MNA-SF did not differ between IG and CG (10.7 ± 2.6 vs. 11.2 ± 2.5, p = 0.148); however, mean BMI was significantly lower in IG compared to CG (27.2 ± 4.7 vs. 28.8 ± 4.8 kg/m2, p = 0.012). At T3m, mean change did not differ significantly between the groups, neither in MNA-SF (0.6; 95%CI: −0.1–1.3 vs. 0.4; −0.3–1.1, p = 0.708) nor in BMI (−0.2; −0.6–0.1 vs. 0.0; −0.4–0.4 kg/m2, p = 0.290). At T12m, mean change of MNA-SF was significantly higher in IG than in CG (1.4; 0.5–2.3 vs. 0.0; −0.9–0.8; p = 0.012). BMI remained unchanged in IG, whereas it slightly declined in CG (0.0; −0.7–0.6 vs. −0.9; −1.6–−0.2 kg/m2, p = 0.034). We observed rather small effects of comprehensive individualized care by pathfinders on NS in older patients 12 months after discharge. For more pronounced effects nutrition expertise might be needed.

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Increasing Awareness and Use of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.15523 ◽

2019 ◽

Author(s):

Yasmin Jahan ◽

Michiko Moriyama ◽

Md Moshiur Rahman ◽

Kana Kazawa ◽

Atiqur Rahman ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Health Education ◽

Rural Community ◽

Mobile Health ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Lifestyle Behaviors ◽

Randomized Controlled ◽

Mhealth Technology

BACKGROUND Hypertension remains one of the foremost noncommunicable diseases that most often lead to cardiovascular diseases and its different complications. The prevalence of hypertension in Bangladesh has been increasing. However, there are very limited studies that have evaluated the impact of health education and awareness development in mitigating the burden of hypertension and its complications in Bangladesh. OBJECTIVE This study aims to increase awareness, enhance knowledge, and change lifestyle behaviors through health education and the use of mobile health (mHealth) technology among individuals with hypertension living in a rural community of Bangladesh. METHODS A randomized controlled trial is underway in a Mirzapur subdistrict of Bangladesh. This trial compares two groups of individuals with hypertension: The comparison arm receives health education and the intervention arm receives health education and a periodic mobile phone–based text message intervention. The trial duration is 5 months. The primary end point is participants’ actual behavior changes brought about by increased awareness and knowledge. RESULTS Enrollment of participants started in August 2018, and collection of follow-up data was completed at the end of July 2019. A total of 420 participants volunteered to participate, and among them, 209 and 211 were randomly allocated to the intervention group and the control group, respectively. Among them, the ratio of males/females was 12.0/88.0 in the intervention group and 16.1/83.9 in the control group. Data cleaning and analyses have been completed and the results have been submitted for publication. CONCLUSIONS Periodic short education using mHealth technology in addition to face-to-face health education may be an effective method for increasing awareness and knowledge about behavioral changes and maintaining healthy lifestyle behaviors. CLINICALTRIAL Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104, https://clinicaltrials.gov/ct2/show/NCT03614104; University hospital Medical Information Network (UMIN) R000033736, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000033736 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15523

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Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial (Preprint)

10.2196/preprints.14754 ◽

2019 ◽

Author(s):

Mark B Schure ◽

Janet C Lindow ◽

John H Greist ◽

Paul A Nakonezny ◽

Sandra J Bailey ◽

...

Keyword(s):

Suicidal Ideation ◽

Rural Community ◽

Symptom Severity ◽

Intervention Group ◽

Effect Sizes ◽

Control Group ◽

Depression Symptoms ◽

Depression Symptom ◽

Cognitive Behavior ◽

Community Population

BACKGROUND Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. OBJECTIVE The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. METHODS Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation. RESULTS Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; <italic>P</italic><.001), with a moderate treatment effect size (<italic>d</italic>=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (<italic>P</italic><.001; <italic>d</italic>=0.47), work/social functioning (<italic>P</italic><.001; <italic>d</italic>=0.39), and resilience (<italic>P</italic><.001; <italic>d</italic>=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55). CONCLUSIONS These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention. CLINICALTRIAL ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878

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Expert-based medication reviews to reduce polypharmacy in older patients in primary care: a northern-Italian cluster-randomised controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02612-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Angelika Mahlknecht ◽

Christian J. Wiedermann ◽

Marco Sandri ◽

Adolf Engl ◽

Martina Valentini ◽

...

Keyword(s):

Older Patients ◽

Primary Outcome ◽

Hospital Admissions ◽

Controlled Trial ◽

Intervention Group ◽

Cluster Randomised Controlled Trial ◽

Control Group ◽

Evidence Based ◽

Cluster Randomised ◽

Randomised Controlled

Abstract Background Evidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical benefits for older patients (aged 75+) by means of evidence-based reduction of polypharmacy (defined as ≥8 prescribed drugs) and inappropriate prescribing in general practice. Methods The cluster-randomised controlled trial involved general practitioners and patients in a northern-Italian region. The intervention consisted of a review of patient’s medication regimens by three experts who gave specific recommendations for drug discontinuation. Main outcome measures were non-elective hospital admissions or death within 24 months (composite primary endpoint). Secondary outcomes were drug numbers, hospital admissions, mortality, falls, fractures, quality of life, affective status, cognitive function. Results Twenty-two GPs/307 patients participated in the intervention group, 21 GPs/272 patients in the control group. One hundred twenty-five patients (40.7%) experienced the primary outcome in the intervention group, 87 patients (32.0%) in the control group. The adjusted rates of occurrence of the primary outcome did not differ significantly between the study groups (intention-to-treat analysis: adjusted odds ratio 1.46, 95%CI 0.99–2.18, p = 0.06; per-protocol analysis: adjusted OR 1.33, 95%CI 0.87–2.04, p = 0.2). Hospitalisations as single endpoint occurred more frequently in the intervention group according to the unadjusted analysis (OR 1.61, 95%CI 1.03–2.51, p = 0.04) but not in the adjusted analysis (OR 1.39, 95%CI 0.95–2.03, p = 0.09). Falls occurred less frequently in the intervention group (adjusted OR 0.55, 95%CI 0.31–0.98; p = 0.04). No significant differences were found regarding the other outcomes. Definitive discontinuation was obtained for 67 (16.0%) of 419 drugs rated as inappropriate. About 6% of the prescribed drugs were PIMs. Conclusions No conclusive effects were found regarding mortality and non-elective hospitalisations as composite respectively single endpoints. Falls were significantly reduced in the intervention group, although definitive discontinuation was achieved for only one out of six inappropriate drugs. These results indicate that (1) even a modest reduction of inappropriate medications may entail positive clinical effects, and that (2) focusing on evidence-based new drug prescriptions and prevention of polypharmacy may be more effective than deprescribing. Trial registration Current Controlled Trials (ID ISRCTN: 38449870), date: 11/09/2013.

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Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial

Heart ◽

10.1136/heartjnl-2019-316349 ◽

2020 ◽

Vol 106 (21) ◽

pp. 1658-1664 ◽

Cited By ~ 3

Author(s):

Gianluca Campo ◽

Elisabetta Tonet ◽

Giorgio Chiaranda ◽

Gianluigi Sella ◽

Elisa Maietti ◽

...

Keyword(s):

Quality Of Life ◽

Physical Performance ◽

Older Patients ◽

Exercise Intervention ◽

Low Cost ◽

Intervention Group ◽

Daily Activities ◽

Control Group ◽

Coronary Syndrome

ObjectiveTo establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS).MethodsThe study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4–9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded.ResultsOverall, 235 patients with ACS (median age 76 (73–81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70–90) vs 70 (50–80) points, p<0.001 and at 1 year 75 (70–87) vs 65 (50–80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04).ConclusionsThe proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit.Trial registration numberNCT03021044.

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