Feasibility of a randomized hypertension screening initiative in the perioperative setting

Objectives This study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs. counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions. Methods A prospective randomized feasibility study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults, with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment; and felt satisfied with the study. Results There were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EHR. Thirty-six (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their primary care provider. Seventeen of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. Sixty-one participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied. Conclusions This feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment. Trial registration Clinicaltrials.gov, NCT03634813. Registered 16 of August 2018.

Voice Enabled Home Automation System

In this era of automation innovation, life is getting less demanding, simpler and the world is getting smarter. IoT gives us the power of internet, data processing and analytics to handle or control the real world. All the day to day entities can take instructions or data from the internet to function without human intervention. Home automation is the automatic control of the electronic home appliances i.e. these appliances along with being controlled manually by switches, can also be controlled through mobiles, laptops and human voice. To accomplish this, AWS IoT core has been used that allows connection of multiple devices on internet without the need of servers. Along with AWS, ESP8266 module is used which helps connect all appliances to the internet along with all the other sensors. Python programming language is used to enable voice control.

Experts prioritize osteoarthritis non-surgical interventions from Cochrane systematic reviews for translation into “Evidence4Equity” summaries

Objective Osteoarthritis generates substantial health and socioeconomic burden, which is particularly marked in marginalized groups. It is imperative that practitioners have ready access to summaries of evidence-based interventions for osteoarthritis that incorporate equity considerations. Summaries of systematic reviews can provide this. The present study surveyed experts to prioritize a selection ofinterventions, from which equity focused summaries will be generated. Specifically, the prioritized interventions will be developed into Cochrane Evidence4Equity (E4E) summaries. Methods Twenty-seven systematic reviews of OA interventions were found. From these, twenty-nine non-surgical treatments for osteoarthritis were identified, based on statistically significant findings for desired outcome variables or adverse events. Key findings from these studies were summarised and provided to 9 experts in the field of osteoarthritis.. Expert participants were asked to rate interventions based on feasibility, health system effects, universality, impact on inequities, and priority for translation into equity based E4E summaries. Expert participants were also encouraged to make comments to provide context for each rating. Free text responses were coded inductively and grouped into subthemes and themes. Results Expert participants rated the intervention home land-based exercise for knee OA highest for priority for translation into an E4E summaries, followed by the interventions individual land-based exercise for knee OA, class land-based exercise for knee OA, exercise for hand OA and land-based exercise for hip OA. Upon qualitative analysis of the expert participants’ comments, fifteen subthemes were identified and grouped into three overall themes: (1) this intervention or an aspect of this intervention is unnecessary or unsafe; (2) this intervention or an aspect of this intervention may increase health inequities; and (3) experts noted difficulties completing rating exercise. Conclusion The list of priority interventions and corresponding expert commentary generated information that will be used to direct and support knowledge translation efforts.

Feasibility of a Pilot Randomized Hypertension Screening Initiative in the Preoperative Setting.

Objectives: This pilot study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions.Methods: A prospective randomized pilot study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment and felt satisfied with the study.Results: There were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EMR. 36 (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their Primary Care provider. 17 of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. 61 participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied. Conclusions: This pilot study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment. Trial Registration: Clinicaltrials.gov, NCT03634813. Registered 16 of August 2018, https://clinicaltrials.gov/ct2/show/NCT03634813

Additional effects of core stability exercises on pain and function of patients with patellofemoral pain: A randomized controlled trial

Background/purpose: Recently, there is more emphasis on the role of core muscles in pathogenesis and rehabilitation of patellofemoral pain (PFP). We aimed to investigate whether increased core muscle strength and endurance improve clinical outcomes. Methods: In a randomized controlled trial, 60 patients (M/F: 25/35, age = 32.28 (5.9) years) with PFP were randomly allocated into two groups of routine exercise (control) and combined core plus routine exercise (intervention). Home exercise was scheduled at least 5 times/week for 12 weeks. We assessed the outcomes of pain (Visual analogue scale) and function (Anterior knee pain score) before and immediately after interventions. Results: Significant improvements were reported in both groups (P < 0.001). There were significant between-group differences in both outcomes in favor of the intervention (Pain: 12.4, CI 95%: 7.1–17.8, P < 0.001; Function: 6.4, CI 95%: 2.2–10.5, P = 0.003). Conclusion: Outcome improvements were significantly greater in intervention group. Inclusion of core stability exercises may lead to additional benefits.

Examining Caregivers’ Independence in Early Intervention Home Visit Sessions

The purpose of this study was to examine how a delineated coaching process affected the ability of caregivers to take the lead in promoting their children’s learning in the context of daily activities. In addition, the correspondence between caregivers’ initiations during the intervention and their rate of improvement after the intervention was investigated. One provider coached three culturally diverse caregivers to use development-enhancing strategies with their children who evidenced moderate–severe disabilities. The coaching process designated by the acronym SOOPR, include targeted information sharing (S), observation and provision of opportunities for the caregiver to practice new skills with provider feedback (OO), problem solving and reflection (P), and review of the session (R). Results reveal that all three caregivers increased their initiations of three of four development-promoting behaviors: teaching, responsiveness, and encouragement. The descriptive data across sessions for each triad suggest that as the intervention progressed, the frequency of specific coaching strategies decreased which may have fostered the caregivers’ opportunities to take the lead in the sessions. In addition, a consistent pattern of direct proportionality between caregiver rate of improvement after the intervention and caregiver initiations during the intervention was identified. Study limitations and implications for research and practice are discussed.

An Exploratory Electrical Stimulation Protocol in the Management of an Infant With Spina Bifida: A Case Report

An infant with myelomeningocele and underdevelopment of the thoracic spinal cord was treated with 2 protocols of electrical stimulation: functional electrical stimulation and transcutaneous spinal cord electrical stimulation. The protocols were incorporated into the infant’s outpatient early intervention home programs. Prior to initiation of electrical stimulation treatment at age 6 months, the infant exhibited complete loss of sensation below the level of T8 and muscular paralysis below the level of T10. The unexpected emergence of somatosensory responses and spontaneous movements in the trunk and lower extremities are described, focusing on the electrical stimulation protocols. Spinal cord electrical stimulation protocols were not previously described in the medical literature regarding the management of children with spina bifida. Both functional and spinal cord electrical stimulation protocols used with this infant proved safe and well tolerated. The experience gained over 12 months of treatment is the subject of this case report.

The Welfare Effects of Nudges: A Case Study of Energy Use Social Comparisons

“Nudge”-style interventions are often deemed successful if they generate large behavior change at low cost, but they are rarely subjected to full social welfare evaluations. We combine a field experiment with a simple theoretical framework to evaluate the welfare effects of one especially policy-relevant intervention, home energy social comparison reports. In our sample, the reports increase social welfare, although traditional evaluation approaches overstate gains because they ignore significant costs incurred by nudge recipients. Overall, home energy report welfare gains might be overstated by $620 million. We develop a prediction algorithm for optimal targeting; this approach would double the welfare gains. (JEL C93, D91, L95, Q41, Q48)