The Impact of Monitoring Depth of Anesthesia and Nociception on Postoperative Cognitive Function in Adult Multiple Trauma Patients

Background and Objectives: Patients with traumatic injuries have often been excluded from studies that have attempted to pinpoint modifiable factors to predict the transient disturbance of the cognitive function in the postoperative settings. Anesthetists must be aware of the high risk of developing postoperative delirium and cognitive dysfunction (POCD) in patients undergoing emergency surgery. Monitoring the depth of anesthesia in order to tailor anesthetic delivery may reduce this risk. The primary aim of this study was to improve the prevention strategies for the immediate POCD by assessing anesthetic depth and nociception during emergency surgery. Material and Methods: Of 107 trauma ASA physical status II–IV patients aged over 18 years undergoing emergency noncardiac surgery, 95 patients were included in a prospective randomized study. Exclusion criteria were neurotrauma, chronic use of psychoactive substances or alcohol, impaired preoperative cognitive function, pre-existing psychopathological symptoms, or expected surgery time less than 2 h. Entropy and Surgical Pleth Index (SPI) values were constantly recorded for one group during anesthesia. POCD was assessed 24 h, 48 h, and 72 h after surgery using the Neelon and Champagne (NEECHAM) Confusion Scale. Results: Although in the intervention group, fewer patients experienced POCD episodes in comparison to the control group, the results were not statistically significant (p < 0.08). The study showed a statistically significant inverse correlation between fentanyl and the NEECHAM Confusion Scale at 24 h (r = −0.32, p = 0.0005) and 48 h (r = −0.46, p = 0.0002), sevoflurane and the NEECHAM Confusion Scale at 24 h (r = −0.38, p = 0.0014) and 48 h (r = −0.52, p = 0.0002), and noradrenaline and POCD events in the first 48 h (r = −0.46, p = 0.0013 for the first 24 h, respectively, and r = −0.46, p = 0.0002 for the next 24 h). Conclusions: Entropy and SPI monitoring during anesthesia may play an important role in diminishing the risk of developing immediate POCD after emergency surgery.

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A Randomized Study to Assess the Impact of Pharmacist Counseling of Employer-Based Health Plan Beneficiaries With Diabetes

Journal of Pharmacy Practice ◽

10.1177/0897190011418513 ◽

2011 ◽

Vol 25 (2) ◽

pp. 169-179 ◽

Cited By ~ 29

Author(s):

Dale F. Kraemer ◽

Wayne A. Kradjan ◽

Theresa M. Bianco ◽

Judi A. Low

Keyword(s):

Diabetes Management ◽

Statistical Significance ◽

Glycosylated Hemoglobin ◽

Randomized Study ◽

Intervention Group ◽

Control Group ◽

Counseling Intervention ◽

Care Plans ◽

Pharmacist Counseling ◽

The Impact

Objective: To assess the impact of pharmacist counseling on empowering people with diabetes to better self-care. Introduction: Community-based pharmacists can play a key role in educating and empowering people in such programs. Methods: A randomized trial compared the effects of pharmacist counseling (intervention group) with printed materials (control group) in diabetic beneficiaries of several employer-based health care plans. All participants also received waiver of out-of-pocket expenses for diabetic-related medications and supplies. Clinical, humanistic, and claim outcomes were evaluated at baseline and at 1 year follow-up. Results: Sixty-seven beneficiaries participated in this study. The 0.50% decrease from baseline in glycosylated hemoglobin (A1c) was statistically significant ( P = .0008) in the intervention group and the difference between the groups approached statistical significance ( P = .076). Beneficiaries in both groups had greater claim costs for diabetic-related medications and supplies during the study year. Both groups also improved in ability to manage their diabetes with the counseling group showing a significantly better understanding of diabetes ( P = .0024). Conclusion: There was a trend toward improvement in A1c in patients counseled by pharmacist with an increased utilization of diabetes-related medications and supplies. Counseling also improved diabetes knowledge and empowered patients to better diabetes management.

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Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.661355 ◽

2021 ◽

Vol 8 ◽

Author(s):

Théo Pezel ◽

Anne Bernard ◽

Yoan Lavie Badie ◽

Julien Dreyfus ◽

Etienne Audureau ◽

...

Keyword(s):

Randomized Study ◽

Intervention Group ◽

Medical Residents ◽

Control Group ◽

Traditional Teaching ◽

Single Center ◽

Simulation Based ◽

Simulator Study ◽

And Performance ◽

The Impact

Introduction: Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology.Materials and Methods: Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of >70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition.Results: All residents will undergo both a theoretical test (0–100 points) and a practical test on a TEE simulator (0–100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training.Conclusion: Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.

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Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Scientific Reports ◽

10.1038/s41598-020-78221-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Vivien Berthoud ◽

Maxime Nguyen ◽

Anouck Appriou ◽

Omar Ellouze ◽

Mohamed Radhouani ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

Primary Outcome ◽

Randomized Study ◽

Intervention Group ◽

Prospective Randomized Study ◽

Control Group ◽

Standard Group ◽

Postoperative Course ◽

The Impact

AbstractPupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

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“Body & Brain”: effects of a multicomponent exercise intervention on physical and cognitive function of adults with dementia - study protocol for a quasi-experimental controlled trial

BMC Geriatrics ◽

10.1186/s12877-021-02104-1 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Joana Carvalho ◽

Flávia Borges-Machado ◽

Duarte Barros ◽

Arnaldina Sampaio ◽

Inês Marques-Aleixo ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Function ◽

Exercise Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Health And Social Care ◽

Quasi Experimental ◽

The Impact

Abstract Background Dementia is a leading cause of death and disability that was declared as one of the greatest health and social care challenges of the twenty-first century. Regular physical activity and exercise have been proposed as a non-pharmacological strategy in disease prevention and management. Multicomponent Training (MT) combines aerobic, strength, balance and postural exercises and might be an effective training to improve both functional capacity and cognitive function in individuals with dementia (IwD). Nevertheless, data on the effects of MT in IwD are still limited and the extent to which IwD can retain improvements after an exercise intervention still needs to be elucidated. The aim of “Body & Brain” study is to investigate the effects of a 6-month MT intervention and 3-month detraining on the physical and cognitive function of IwD. Additionally, we aim to explore the impact of this intervention on psychosocial factors and physiologic markers related to dementia. Methods This study is a quasi-experimental controlled trial using a parallel-group design. The study sample consists of community-dwelling individuals aged ≥60 years who are clinically diagnosed with dementia or major neurocognitive disorder. Participants will be either allocated into the intervention group or the control group. The intervention group will participate in MT biweekly exercise sessions, whereas the control group will receive monthly sessions regarding physical activity and health-related topics for 6 months. The main outcomes will be physical function as measured by the Short Physical Performance Battery (SPPB) and cognitive function evaluated using the Alzheimer Disease Assessment Scale – Cognitive (ADAS-Cog) at baseline, after 6-months and 3-months after the end of intervention. Secondary outcomes will be body composition, physical fitness, daily functionality, quality of life, neuropsychiatric symptoms and caregiver’s burden. Cardiovascular, inflammatory and neurotrophic blood-based biomarkers, and arterial stiffness will also be evaluated in subsamples. Discussion If our hypothesis is correct, this project will provide evidence regarding the efficacy of MT training in improving physical and cognitive function and give insights about its impact on novel molecular biomarkers related to dementia. This project may also contribute to provide guidelines on exercise prescription for IwD. Trial registration ClinicalTrials.gov – identifier number NCT04095962; retrospectively registered on 19 September 2019.

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Effects of the Interactive Web-Based Video “Mon Coeur, Mon BASIC” on Drug Adherence of Patients with Myocardial Infarction: A Randomized Study (Preprint)

10.2196/preprints.21938 ◽

2020 ◽

Author(s):

Christel Bruggmann ◽

Julien Adjedj ◽

Sylvain Sardy ◽

Olivier Muller ◽

Pierre Voirol ◽

...

Keyword(s):

Emergency Room ◽

Interactive Video ◽

Randomized Study ◽

Intervention Group ◽

Control Group ◽

Drug Adherence ◽

Emergency Room Visits ◽

Web Based ◽

The Difference ◽

The Impact

BACKGROUND Secondary prevention strategies after acute coronary syndrome (ACS) presentation with the use of drug combinations are essential to reduce the recurrence of cardiovascular events. However, the lack of drug adherence is known to be common in this population, and to be related to treatment failure. To improve drug adherence, we developed the “Mon Coeur, Mon BASIC” web-based interactive video to inform patients about ACS and their drug treatments. OBJECTIVE To assess the impact of the web-based video on drug adherence. METHODS This randomized study was conducted with consecutive patients admitted to Lausanne University Hospital for ACS. We randomized patients to an intervention group, which had access to the video, and a control group receiving usual care. The primary outcome was the difference in drug adherence, assessed with the Adherence to Refills and Medication Scale [ARMS; nine multiple-choice questions, scores ranging from 12 (perfect adherence) to 48 (lack of adherence)], between groups at 1, 3, and 6 months. We assessed the difference in ARMS score between both groups with Wilcoxon rank sum test. Secondary outcomes were differences in knowledge and readmissions and emergency room visits between groups, and patients’ satisfaction with the video. RESULTS Sixty patients were included at baseline. The median age of the participants was 59 (IQR 49–69) and 85% were male. At 1 month, 51 patients participated in the follow up, 50 patients participated at 3 months, and 47 patients participated at 6 months. The mean ARMS scores at 1 and 6 months did not differ between the intervention and control groups (13.24 and 13.15, 13.52 and 13.68, respectively). At 3 months, this score was significantly lower in the intervention group than in the control group (12.54 vs. 13.75, P = .034). We observed significant increases in knowledge from baseline to 1 and 3 months, but not to 6 months, in the intervention group. Readmissions and emergency room visits have been very rare and the proportion was not different among groups. Patients in the intervention group were highly satisfied with the video. CONCLUSIONS The “Mon Coeur, Mon BASIC” web-based interactive video improved patients’ knowledge and seemed to have an impact on drug adherence. These results are encouraging, and the video will be offered to all patients admitted to our hospital with ACS. CLINICALTRIAL ClinicalTrials.gov NCT03949608; https://clinicaltrials.gov/ct2/show/NCT03949608

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The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement

Global Spine Journal ◽

10.1177/2192568217743505 ◽

2017 ◽

Vol 8 (6) ◽

pp. 557-562 ◽

Cited By ~ 3

Author(s):

Barrett S. Boody ◽

Sohaib Z. Hashmi ◽

Brett D. Rosenthal ◽

Joseph P. Maslak ◽

Michael H. McCarthy ◽

...

Keyword(s):

Pedicle Screw ◽

Randomized Study ◽

Intervention Group ◽

Training Session ◽

Control Group ◽

Junior Resident ◽

Training Module ◽

Pedicle Screw Instrumentation ◽

The Impact ◽

Lumbar Pedicle

Study Design: Prospective randomized study. Objectives: To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol. Methods: Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models. Results: The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group ( P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches ( P = .001) compared with 28% decrease in the control group ( P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group’s improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047). Conclusions: We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.

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Impact of a Catch-Up Strategy of DT-IPV Vaccination during Hospitalization on Vaccination Coverage among People Over 65 Years of Age in France: The HOSPIVAC Study (Vaccination during Hospitalization)

Vaccines ◽

10.3390/vaccines8020292 ◽

2020 ◽

Vol 8 (2) ◽

pp. 292

Author(s):

Sophie Blanchi ◽

Justine Vaux ◽

Jean Marc Toqué ◽

Ludovic Hery ◽

Servane Laforest ◽

...

Keyword(s):

General Practitioner ◽

Hospital Discharge ◽

Vaccination Coverage ◽

Randomized Study ◽

Intervention Group ◽

Immunization Coverage ◽

Control Group ◽

Sufficient Information ◽

Catch Up ◽

The Impact

In France, diphtheria tetanus and inactivated polio vaccine (DT-IPV) coverage and immunization are insufficient in the elderly and decrease with age. The principal objective of this study was to assess the impact of a strategy of catch-up DT-IPV vaccination during hospitalization in people over the age of 65 years in central France (the Sarthe region). We performed a prospective, single-center, cluster-randomized study (four hospital wards). We included patients aged ≥65 years, without mental impairment, contraindication and who accepted to participate, hospitalized in the internal medicine wards in Le Mans Hospital from 28 May 2018 to 27 May 2019. The DT-IPV vaccination status of the patients was determined at inclusion and the wards were randomized (intervention and control). In the intervention group, vaccination was up-dated during hospitalization. In case of temporary contraindication, vaccination was prescribed at hospital discharge. Patients hospitalized in the control wards received oral information only. Final immunization status was determined by calling the patient’s general practitioner two months after hospital discharge. One hundred and fifty seven patients were included: 73 in the intervention and 84 in the control arm. Baseline immunization coverage was 46.5%. Vaccination coverage increased from 56.2% to 80.8% in the intervention group and from 38.1% to 40.5% in the control group (p < 0.001). Having received sufficient information from the general practitioner was the only factor associated with vaccination being up-to-date in uni- and multivariate analysis: OR = 5.07 [2.45–10.51]. In a setting of low vaccination coverage DT-IPV vaccination during hospitalization is an effective catch-up strategy.

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The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

10.2196/preprints.13507 ◽

2019 ◽

Author(s):

Stéphane Sanchez ◽

Cécile Payet ◽

Marie Herr ◽

Anne Dazinieras ◽

Caroline Blochet ◽

...

Keyword(s):

Nursing Homes ◽

Medical Practice ◽

Intervention Group ◽

Medication Use ◽

Nursing Home Residents ◽

Control Group ◽

Multilevel Regression ◽

Difference In Differences ◽

Good Medical Practice ◽

The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

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The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients

Pharmacy ◽

10.3390/pharmacy9020086 ◽

2021 ◽

Vol 9 (2) ◽

pp. 86

Author(s):

Fauna Herawati ◽

Yuni Megawati ◽

Aslichah ◽

Retnosari Andrajati ◽

Rika Yulia

Keyword(s):

Intervention Group ◽

Personal Control ◽

Control Group ◽

P Value ◽

Interactive Approach ◽

Community Based ◽

Tuberculosis Patients ◽

Level Of Knowledge ◽

The Impact

The long period of tuberculosis treatment causes patients to have a high risk of forgetting or stopping the medication altogether, which increases the risk of oral anti-tuberculosis drug resistance. The patient’s knowledge and perception of the disease affect the patient’s adherence to treatment. This research objective was to determine the impact of educational videos in the local language on the level of knowledge, perception, and adherence of tuberculosis patients in the Regional General Hospital (RSUD) Bangil. This quasi-experimental study design with a one-month follow-up allocated 62 respondents in the intervention group and 60 in the control group. The pre- and post-experiment levels of knowledge and perception were measured with a validated set of questions. Adherence was measured by pill counts. The results showed that the intervention increases the level of knowledge of the intervention group higher than that of the control group (p-value < 0.05) and remained high after one month of follow-up. The perceptions domains that changed after education using Javanese (Ngoko) language videos with the Community Based Interactive Approach (CBIA) method were the timeline, personal control, illness coherence, and emotional representations (p-value < 0.05). More than 95% of respondents in the intervention group take 95% of their pill compared to 58% of respondents in the control group (p-value < 0.05). Utilization of the local languages for design a community-based interactive approach to educate and communicate is important and effective.

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Investigating the Impact of Cognitive Training for Individuals With Bothersome Tinnitus: A Randomized Controlled Trial

Otolaryngology ◽

10.1177/0194599821994742 ◽

2021 ◽

pp. 019459982199474

Author(s):

Maggie Xing ◽

Dorina Kallogjeri ◽

Jay F. Piccirillo

Keyword(s):

Randomized Controlled Trial ◽

Cognitive Training ◽

Mixed Model ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Functional Index ◽

Open Label ◽

Randomized Controlled ◽

The Impact

Objective To evaluate the effectiveness of cognitive training in improving tinnitus bother and to identify predictors of patient response. Study Design Prospective open-label randomized controlled trial. Setting Online. Methods Participants were adults with subjective idiopathic nonpulsatile tinnitus causing significant tinnitus-related distress. The intervention group trained by using auditory-intensive exercises for 20 minutes per day, 5 days per week, for 8 weeks. The active control group trained on the same schedule with non–auditory intensive games. Surveys were completed at baseline, 8 weeks, and 12 weeks. Results A total of 64 participants completed the study. The median age was 63 years (range, 25-69) in the intervention group and 61 years (34-68) in the control group. Mixed model analysis revealed that within-subject change in Tinnitus Functional Index in the intervention group was not different than the control group, with marginal mean differences (95% CI): 0.24 (–11.20 to 10.7) and 2.17 (–8.50 to 12.83) at 8 weeks and 2.33 (–8.6 to 13.3) and 3.36 (–7.91 to 14.6) at 12 weeks, respectively. When the 2 study groups were compared, the control group had higher Tinnitus Functional Index scores than the intervention group by 10.5 points at baseline (95% CI, –0.92 to 29.89), 8.1 at 8 weeks (95% CI, –3.27 to 19.42), and 9.4 at 12 weeks (95% CI, –2.45 to 21.34). Conclusion Auditory-intensive cognitive training was not associated with changes in self-reported tinnitus bother. Given the potential for neuroplasticity to affect tinnitus, we believe that future studies on cognitive training for tinnitus remain relevant.

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