Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

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Fast Track Recovery Surgery with A Whey Protein Infused Carbohydrate Loading Drink Pre-Operatively and Early Oral Feeding Post-Operatively among Surgical Gynaecologic Cancer Patients: Study Protocol of an Open Labelled Randomised Controlled Trial

10.21203/rs.2.11814/v1 ◽

2019 ◽

Author(s):

Chiou Yi Ho ◽

Zuriati Ibrahim ◽

Zalina Abu Zaid ◽

Zulfitri 'Azuan Mat Daud ◽

Nor Baizura Md Yu

Keyword(s):

Hospital Stay ◽

Cancer Patients ◽

Whey Protein ◽

Intervention Group ◽

Oral Feeding ◽

Control Group ◽

Bowel Sound ◽

Early Oral Feeding ◽

Carbohydrate Loading ◽

Gynaecologic Cancer

Abstract Introduction: There has been growing evidence on the favourable outcomes of fast tract recovery (FTR) surgery; expedite recovery, minimise complications, reduce length of hospital stay on surgical patients. However, there is lack of evidence on the effectiveness of FTR in surgical gynaecologic cancer patients. Most of previous study did not focus on feeding composition in FTR surgery protocol. This study aims to determine the effectiveness of FTR feeding with whey protein infused carbohydrate loading drink pre-operatively and early oral feeding post-operatively on post-operative outcomes among surgical gynaecologic cancer patients. Methods and analysis: This open labelled RCT will randomly allocate patients into intervention and control group. Ambulated Malaysian aged over 18 years and scheduled for elective surgery for (suspected) GC, will be included in this study. Intervention group will be given whey protein infused carbohydrate loading drinks evening before operation and 3 hours before operation as well as started on early oral feeding 4 hours post-operatively. Control group will be fasted overnight pre-operation and only allowed plain water, and the diet transition fashion is followed when there is bowel sound post-operatively. Primary outcomes of study are length of post-operative hospital stay, length of clear fluid toleration, solid food toleration and bowel function. Additional outcome measures are changes in nutritional status, biochemical profile and functional status. Data will be analysed on an intention-to-treat basis. Trial Registration Number: ClinicalTrials.gov, NCT03667755. Registered 12 September 2018 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03667755

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Fast Track Recovery Surgery with A Whey Protein Infused Carbohydrate Loading Drink Pre-Operatively and Early Oral Feeding Post-Operatively among Surgical Gynaecologic Cancer Patients: Study Protocol of an Open Labelled Randomised Controlled Trial

10.21203/rs.2.11814/v2 ◽

2020 ◽

Author(s):

Chiou Yi Ho ◽

Zuriati Ibrahim ◽

Nor Baizura Md Yu ◽

Zalina Abu Zaid ◽

Zulfitri 'Azuan Mat Daud

Keyword(s):

Hospital Stay ◽

Cancer Patients ◽

Whey Protein ◽

Intervention Group ◽

Oral Feeding ◽

Control Group ◽

Bowel Sound ◽

Early Oral Feeding ◽

Carbohydrate Loading ◽

Gynaecologic Cancer

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Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

Anesthesiology ◽

10.1097/aln.0000000000001663 ◽

2017 ◽

Vol 127 (1) ◽

pp. 36-49 ◽

Cited By ~ 36

Author(s):

Juan C. Gómez-Izquierdo ◽

Alessandro Trainito ◽

David Mirzakandov ◽

Barry L. Stein ◽

Sender Liberman ◽

...

Keyword(s):

Colorectal Surgery ◽

Fluid Therapy ◽

Postoperative Ileus ◽

Enhanced Recovery ◽

Laparoscopic Colorectal Surgery ◽

Enhanced Recovery After Surgery ◽

Therapy Group ◽

Control Group ◽

Goal Directed Fluid Therapy ◽

The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

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PROPER—PRehabilitatiOn Plus Enhanced Recovery after surgery versus enhanced recovery after surgery in gynecologic oncology: a randomized clinical trial

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-003170 ◽

2021 ◽

pp. ijgc-2021-003170

Author(s):

Andre Lopes ◽

Alayne Magalhães Trindade Domingues Yamada ◽

Thais de Campos Cardenas ◽

Jaqueline Nunes de Carvalho ◽

Emília de Azevedo Oliveira ◽

...

Keyword(s):

Hospital Stay ◽

Functional Capacity ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Preoperative Care ◽

Gynecologic Surgery ◽

Calorie Intake ◽

Control Group ◽

Gynecological Surgery ◽

The Impact

BackgroundPrehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits.Primary ObjectiveTo evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines.Study HypothesisA multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity.Trial DesignProspective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation.Major Inclusion CriteriaPatients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks.Primary EndpointTo compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one’s-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake.Sample Size194 participantsEstimated Dates for Completing Accrual and Presenting ResultsAt present, 30 patients have been recruited. Accrual should be completed by 2023–24.Trial RegistrationThe study is approved by the IBCC – São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

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The association of the affordable care's Medicaid expansion on survival in gynecologic cancer: A National Cancer Database study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1501 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1501-1501

Author(s):

Anna Jo Smith ◽

Jeremy Applebaum ◽

Amanda Nickles Fader

Keyword(s):

Rural Women ◽

Gynecologic Cancer ◽

Intervention Group ◽

Control Group ◽

Cancer Type ◽

National Cancer Database ◽

Medicaid Expansion ◽

Difference In Differences ◽

Significant Difference ◽

One Year

1501 Background: Under the Affordable Care Act’s 2014 Medicaid expansion, more than 12 million Americans gained health insurance. Whether such gains in insurance improve survival in gynecologic cancer is unknown. This study aims to determine whether Medicaid expansion is associated with improved survival among women with gynecologic cancers. Methods: We conducted a retrospective cohort study using a difference-in-differences study design comparing insurance status, stage at diagnosis, delays in treatment, and one-year survival before and after the ACA’s Medicaid expansion in Medicaid expansion states (intervention group) compared to women in non-expansion states (control group). Using hospital-reported data from the 2010-2016 National Cancer Database, we compared outcomes overall for women ages 40-64 years old with endometrial, cervical, ovarian, or vulva/vaginal cancer and then stratified by cancer type, stage, race, and rural/urban status. We adjusted for patient (area-level income, area-level education, distance traveled for care, comorbidities), clinical (co-morbidities, grade) and hospital (academic facility) characteristics. Results: Our sample included 241,713 women with gynecologic cancer, 119,392 in expansion states and 122,321 in non-expansion states. Post-Medicaid expansion, there was a statistically significant 0.8 % increase in 1-year survival among patients in expansion states compared to non-expansion states (95% CI 0.1-1.5). There was also a significant reduction in uninsurance (-1.1%, 95%CI, --1.5, -0.7) and delays of 30+ days from diagnosis to treatment (-2.4%, 95%CI -3.4, -1.2). There was no significant change in early-stage diagnosis (0%; 95%CI -0.7-0.7). Improvements in one-year survival after Medicaid expansion were driven by ovarian cancer (difference-in-differences 2.2%, 95%CI 0.6-3.8) and in white women (difference-in-differences 0.8%, 95%CI 0.1-1.5), while there was no significant difference in one-year survival for non-white or rural women. Conclusions: The Affordable Care Act’s Medicaid expansion was significantly associated with 1-year survival and insurance access among patients with gynecologic cancer. Insurance expansion efforts in non-Medicaid expansion states may improve survival for women with gynecologic cancer.

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Effects of a Meal Replacement on Body Composition and Metabolic Parameters among Subjects with Overweight or Obesity

Journal of Obesity ◽

10.1155/2018/2837367 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Xiaohui Guo ◽

Yifan Xu ◽

Hairong He ◽

Hao Cai ◽

Jianfen Zhang ◽

...

Keyword(s):

Blood Pressure ◽

Body Composition ◽

Total Energy ◽

Intervention Group ◽

Overweight And Obesity ◽

Metabolic Parameters ◽

Control Group ◽

Meal Replacement ◽

Significant Difference ◽

The Impact

Meal replacement plans are effective tools for weight loss and improvement of various clinical characteristics but not sustainable due to the severe energy restriction. The aim of the study was to evaluate the impact of meal replacement, specifically 388 kcal in total energy, on body composition and metabolic parameters in individuals with overweight and obesity from a Chinese population. A parallel, randomized controlled trial was performed with 174 participants (ChiCTR-OOC-17012000). The intervention group (N=86) was provided with a dinner meal replacement, and the control group (N=88) continued their routine diet as before. Body composition and blood parameters were assessed at 0, 4, 8, and 12 weeks. A post hoc analysis (least significant difference (LSD) test), repeated measurements, and pairedT-test were used to compare each variable within and between groups. Significant (p<0.001) improvements in body composition components were observed among the intervention group, including body weight (−4.3 ± 3.3%), body mass index (−4.3 ± 3.3%), waist circumference (−4.3 ± 4.4%), fat-free mass (−1.8 ± 2.9%), and body fat mass (−5.3 ± 8.8%). Body composition improvements corresponded with significant metabolic improvements of blood glucose (−4.7 ± 9.8%). Further improvements in visceral fat area (−7.7 ± 10.1%), accompanying with improvements in systolic (−3.7 ± 6.9%) and diastolic (−5.3 ± 7.7%) blood pressure, were only found in male subjects. To conclude, meal replacement intake with 388 kcal in total energy at dinner time for 12 weeks contributed to improvement in body composition and clinically significant metabolic parameters in both male and female participants with overweight/obesity. Additionally, glucose and blood pressure reduction were gender-specific highlighting the importance of gender stratification for design of nutritional intervention studies for improvement of health.

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Music intervention affects the quality of life on Alzheimer’s disease: a meta-analysis

10.37766/inplasy2021.12.0055 ◽

2021 ◽

Author(s):

Lingyan Zuo ◽

Fengting Zhu ◽

Rui Wang ◽

Hongyan Shuai ◽

Xin Yu

Keyword(s):

Meta Analysis ◽

Intervention Group ◽

Original Data ◽

Controlled Study ◽

Control Group ◽

Music Intervention ◽

Significant Difference ◽

Review Question ◽

Intervention Modality ◽

The Impact

Review question / Objective: Inclusion criteria: population: 1) A randomized controlled study on the impact of music intervention on the QOL of patients with AD; 2) The participants in this study is patients with AD; 3) There is no significant difference among age, gender and education background in sorted groups before analysis which make these groups comparable; intervention: 1)Intervention Modality Music-based intervention; comparison: 1) All data were sorted into two groups: the music intervention group and the control group without any music intervention; outcome: 1) The indicators evaluated in the literature included the score of QOL-AD or WHOQOL-BERF scale, at least one of the two scales summarized in selected publications; language: 1) Only articles published in English and Chinese were considered. Exclusion criteria: 1) The participants were not diagnosed with AD; 2) Non-musical intervention;3) Non-RCTs; 4) No specific values for outcome variables; 5) Articles lacking original data; 6) Repeat published reports; 7) Full text could not be obtained.

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Real Life Clinical Impact of Antimicrobial Stewardship Actions on the Blood Culture Workflow from a Microbiology Laboratory

Antibiotics ◽

10.3390/antibiotics10121511 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1511

Author(s):

Jose Maria López-Pintor ◽

Javier Sánchez-López ◽

Carolina Navarro-San Francisco ◽

Ana Maria Sánchez-Díaz ◽

Elena Loza ◽

...

Keyword(s):

Blood Culture ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Intervention Group ◽

Real Life ◽

Antimicrobial Susceptibility Testing ◽

Control Group ◽

Correct Treatment ◽

Significant Difference ◽

The Impact

Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of a rapid blood culture workflow protocol in positive blood cultures with Gram-negative bacilli (GNB). Methods: A quasi-experimental before–after study was performed with two groups: (i) control group (conventional work-protocol) and (ii) intervention group (rapid workflow-protocol: rapid identification by Matrix-Assisted Laser Desorption/Ionization-Time-Of-Flight (MALDI-TOF) and antimicrobial susceptibility testing (AST) from bacterial pellet without overnight incubation). Patients were divided into different categories according to the type of intervention over treatment. Outcomes were compared between both groups. Results: A total of 313 patients with GNB-bacteremia were included: 125 patients in the control group and 188 in the intervention. The time from positive blood culture to intervention on antibiotic treatment decreased from 2.0 days in the control group to 1.0 in the intervention group (p < 0.001). On the maintenance of correct empirical treatment, the control group reported 2.0 median days until the clinical decision, while in the intervention group was 1.0 (p < 0.001). In the case of treatment de-escalation, a significant difference between both groups (4.0 vs. 2.0, p < 0.001) was found. A decreasing trend on the change from inappropriate treatments to appropriate ones was observed: 3.5 vs. 1.5; p = 0.12. No significant differences were found between both groups on 7-days mortality or on readmissions in the first 30-days. Conclusions: Routine implementation of a rapid workflow protocol anticipates the report of antimicrobial susceptibility testing results in patients with GNB-bacteremia, decreasing the time to effective and optimal antibiotic therapy.

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The impact of using BASNEF model on self-control behaviors among Patients with hypertension

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v3i3.127 ◽

2018 ◽

Vol 3 (3) ◽

pp. 112

Author(s):

Moradali Zareipour ◽

Mousa Ghelichi Ghojogh ◽

Masoumeh Mahdi-akhgar ◽

Sarvin Abbasi ◽

Nooshin Yoshany ◽

...

Keyword(s):

Blood Pressure ◽

Intervention Group ◽

Public Health Problem ◽

Developed Countries ◽

Self Control ◽

Control Group ◽

Validity And Reliability ◽

Important Public Health Problem ◽

Significant Difference ◽

The Impact

Background: High blood pressure is the most important public health problem in developed countries. It is one reason for early mortality and risk factors for cardiovascular diseases like stroke and kidney failure. This study aimed to determine the effect of educational intervention based on BASNEF in blood pressure control in 1395.Methods and Materials: This study was a quasi-experimental study on 160 patients in two groups (each n = 80) suffering from hypertension in urban health centers of Urmia. Data collection questionnaire included: demographic questions, knowledge base questions, self-control behaviors questions and structures of BASNEF model. Validity and reliability were respectively 80% and 79%. Intervention group had taken three 45 minutes sessions using speeches, questions and answers, posters, booklets, pamphlets and whiteboard. Before training, information collected through questionnaires and after training questionnaires were completed again after 3 months. The data were analyzed in SPSS software with chi-square tests, Fisher, independent and paired sample t-test.Results: The average age of case and control group were 99.11 ± 01.56 and 75.12 ± 66.53 years. That there was no statistically significant difference (p=0.1). After intervention average systolic blood pressure significantly decreased in the intervention group from 43.157 to 24.147 mm Hg and diastolic blood pressure significantly decreased from 21.93 to 52.87 mm Hg (P <0.05)Conclusion: The training program using BASNEF model has provided better results in controlling blood pressure than conventional trainings.

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The impact of a peer-based education on fruits and vegetables intake among housewives

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00278-3 ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Roya Sheybani ◽

Zahra Hosseini ◽

Sayed Hossein Davoodi ◽

Teamur Aghamolaei ◽

Amin Ghanbarnejad

Keyword(s):

Self Efficacy ◽

Fruits And Vegetables ◽

Group Discussion ◽

Peer Education ◽

Intervention Group ◽

Control Group ◽

Post Intervention ◽

Significant Difference ◽

Quasi Experimental ◽

The Impact

Abstract Background Evidence indicates the lower intake of fruits and vegetables than the recommended daily amount. Study aimed at determining the effects of peer education intervention on the consumption of fruits and vegetable in housewives. Methods A quasi-experimental was conducted with 130 housewives referring to health care centers in Bandar Abbas, Iran. Sixty-five subjects were recruited in each of the intervention and the control groups. Intervention group were divided into three subgroups each receiving a seven-sessions educational programs (lecturing and group discussion) through peers about the importance of benefits of fruits and vegetables consumption. Participants were followed for two months. Data were collected using a questionnaire in two stages of pre- and post-intervention. Differences in the outcome before and after the intervention were tested using T-test and paired T-test. Results The daily servings of fruits and vegetables in the intervention group increased from 1.73 to 4.20 and in the control group from 1.96 to 2.16; a statistically significant difference was also observed between the groups (P < 0.001). After the intervention benefits and self-efficacy of fruits and vegetables consumption significantly increased and perceived barriers of fruits and vegetables consumption significantly decreased in the intervention group (P < 0.001). Conclusion Peer education improves benefits and self-efficacy, reduces barriers, and increases the daily servings of fruits and vegetables in housewives.

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