Efficacy of Mobile Phone Technology for Managing Side Effects Associated with Chemotherapy among Cancer Patients: A Systematic Review and Meta-Analysis

Background To establish the evidence related to the efficacy of mobile phone technology for managing side effects of chemotherapy and improved quality of life among patients with cancer. Methods Articles published in peer-reviewed journals were included in this review. Randomized control trials (RCTs) and non-randomized control trials (non-RCTs) consisting of mobile-based interventions (mobile application, smart phone App-based interventions or guidelines to manage side-effects of chemotherapy or mobile health services), and adult cancer patients (aged 18 or above years) as participants who were undergoing chemotherapy and received mobile phone-based interventions as an interventional group versus control/comparator group who were getting routine or usual care were included in this systematic review. Databases such as Scopus, Science Direct, Cochrane library, PubMed, and Google Scholar were systematically searched between 2007 and 2020. Using the Cochrane risk of bias tool, the methodological quality of the included studies was evaluated by two independent authors. Results We included 10 trials, involving 1467 cancer patients and the number of participants ranged from 50 to 457. All trials measured the side effects of chemotherapy as the main outcome and three trials measured the quality of life as the main outcome.Ten trials included for narrative synthesis showed a significant decrease in chemotherapy side effects and considerable improvement in the quality of life in the interventional group than in the comparison group. Meta-analysis of four RCTs containing 803 subjects concluded a significant improvement (p < 0.0001) in the quality of life.A significant improvement in the quality of life was revealed by random effects model (SMD = 0.31, 95% CI: 0.17, −0.46) and a significant difference (Z = 4.37, p < 0.001) was identified between experimental and control groups. Conclusion Current review strengthens the evidence that utilizing mobile-phone based technology has favorable effects on improving the quality of life by minimizing side-effects associated with chemotherapy among cancer patients.

Role of Vitamin D in Reducing the Frequency of Asthma Attacks in Patients with Frequent Exacerbation of Asthma

Introduction: Vitamin D deficiency is common among asthmatics with literature suggesting that its low levels in the body may trigger exacerbations and decrease the response to corticosteroid treatment. It has also shown to inhibit the production of cytokines, which in turn enhances the body’s response to corticosteroid treatment during an exacerbation. Therefore, maintenance of adequate levels of vitamin D in patients with asthma may reduce the risk of exacerbation and improve their general health. This study aims to explore the role of vitamin D supplementation in preventing asthma exacerbations. Methods: This single blind parallel arm interventional study was conducted in the pulmonology ward in a tertiary care hospital from June 2018 to April 2020. Two hundred (n= 200) participants with a history of frequent acute exacerbation of asthma were enrolled in the study via consecutive convenient non-probability technique. Participants were divided into two groups; the placebo and the interventional group that received 200,000 IU of vitamin D capsule. Results: Compared to day 0, mean episodes of exacerbation in the interventional group were significantly lower after 180 days (1.1 ± 0.4 vs. 0.61 ± 0.3; p-value <0.0001). Similarly, number of asthma attacks in past 7 days was significantly lower in intervention group after 180 days (4.4 ± 2.7 vs. 3.1 ± 1.5; p-value 0.0001) Conclusion: Vitamin D supplementation is a safe and cost-friendly approach to reducing asthma exacerbations. It may also help to improve the condition in severe asthmatics with low vitamin D levels.

Treatment of classic mid-trimester preterm premature rupture of membranes (PPROM) with oligo/ anhydramnion between 22 – 26 weeks’ gestation by means of continuous amnioinfusion: a randomized multicentric prospective controlled TRIAL

Background: The classic mid-trimester preterm premature rupture of membranes (PPROM), is defined as rupture of fetal membranes prior to 28 weeks’ gestation (WG) with oligo/ anhydramnion, complicates approximately 0.4-0.7% of all pregnancies and is associated with very high neonatal mortality and morbidity.Antibiotics have limited success to prevent bacterial growth, chorioamnionitis and fetal inflammation. The repetitive amnioinfusion doesn’t work because of immediately fluid lost after the intervention. The continuous amnioinfusion through the transabdomianal port system or catheter in patients with classic PPROM shows promise by flush out of bacteria and inflammatory components from the amniotic cavity, replacing amniotic fluid and thus prolonging PPROM-to-delivery interval.Aim: This multicenter trial tests the effect of continuous amnioinfusion on the neonatal survival without the typical major morbidities, like severe bronchopulmonary dysplasia, intraventricular hemorrhage, cystic periventricular leukomalacia and necrotizing enterocolitis one year after the delivery.Methods/Design: randomized multicenter trial; two-arm parallel design. Control group: PPROM patients between 22/0 (20/0) -26/0 WG treated with antibiotics and corticosteroids in accordance to guidelines of German Society of Obstetrics and Gynecology (standard PPROM therapy). In the interventional group the standard PPROM therapy will be complemented by “Amnion Flush Method” with the amnioinfusion of artificial amniotic fluid (up to 100 ml/h, 2400 ml/day).Subjects: 68 patients with classic PPROM between 22/0 (20/0)-26/0 WG.TRIAL-registration: ClinicalTrials.gov ID: NCT04696003 and German Clinical Trials Register: DRKS00024503, January 2021.The trial is approved by the Ethic committee of the Martin-Luther University Halle-Wittenberg (2020-185, January 25, 2021).

Center of pressure (COP) measurement in patients with confirmed successful outcomes following shoulder surgery show significant sensorimotor deficits

Purpose To determine the sensorimotor and clinical function of patients with confirmed successful outcome after either undergoing acromioclavicular joint (ACJ) stabilization, Bankart repair (BR), or rotator cuff repair (RC), and to compare these measures to the contralateral, healthy side without history of previous injuries or surgeries of the upper extremity. It was hypothesized that patients of each interventional group would have inferior sensorimotor function of the shoulder joint compared to the contralateral, healthy side, while presenting with successful clinical and functional outcomes. Methods Three intervention groups including ten patients who had confirmed successful clinical and functional outcomes after either undergoing ACJ stabilization, BR, or RC were evaluated postoperatively at an average follow-up of 31.7 ± 11.6 months. Additionally, a healthy control group (CG) of ten patients was included. Clinical outcomes were assessed using the Constant–Murley (CM) and American Shoulder and Elbow Surgeons (ASES) Score. Pain was evaluated using the visual analogue scale (VAS). Sensorimotor function was assessed by determining the center of pressure (COP) of the shoulder joint in a one-handed support task in supine position on a validated pressure plate. Results Each interventional group demonstrated excellent clinical outcome scores including the CM Score (ACJ 83.3 ± 11.8; BR 89.0 ± 10.3; RC 81.4 ± 8.8), ASES Score (ACJ 95.5 ± 7.0; BR 92.5 ± 9.6; RC 96.5 ± 5.2), and VAS (ACJ 0.5 ± 0.9; BR 0.5 ± 0.8; RC 0.5 ± 0.8). Overall, the CG showed no significant side-to-side difference in COP, whereas the ACJ-group and the BR-group demonstrated significantly increased COP compared to the healthy side (ACJ 103 cm vs. 98 cm, p = 0.049; BR: 116 cm vs. 102 cm, p = 0.006). The RC-group revealed no significant side-to-side difference (120 cm vs. 108 cm, n.s.). Conclusion Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. This may indicate that specific postoperative training and rehabilitation protocols should be established for patients who underwent surgery of the upper extremity. These results underline that sensorimotor training should be an important component of postoperative rehabilitation and physiotherapeutic activities to improve postoperative function and joint control. Level of evidence IV.

772. Effect of Selective Digestive Decontamination Using Oral Colistin on HAI Rates and All-Cause Mortality Among Cardiovascular Surgery Patients - A Single Centre Experience from India

Background Hospital acquired infections affect the morbidity and mortality of ICU patients considerably. Selective digestive decontamination (SDD) is defined as the prophylactic application of topical, non-absorbable antimicrobials in the oropharynx and stomach, with the goal of eradicating potentially pathogenic microorganisms but preserving the protective anaerobic microbiota. SDD has been applied in trials among critically ill patients and found to be effective in reducing HAI. Methods This cohort study was conducted in our cardiothoracic vascular surgery ICU of a tertiary care hospital, where patients were given oral colistin syrup (100mg 6th hourly for 5 days) in the immediate post op during the intervention period. We compared the clinical and microbiological outcomes of patients before (5 months, pre-intervention arm) and after (5 months, intervention arm) the implementation of SDD (Oral colistin syrup). Results A total of 78 patients were included in the interventional arm with a mean age of 58.7 years whereas the pre-interventional group consisted of 94 study participants with a median age of 57.5 years. 11 out of 94 had positive respiratory sample culture (11.7%) in the preintervention group which mandated antibiotic therapy for HAP compared to one culture positive in the interventional period (OR 0.0980, 95% CI: 0.0124 to 0.777 and P=0.0279). One patient had blood stream infection in the pre-intervention period compared to none in the intervention phase. All-cause mortality in the pre-interventional group was 7.44% (7 in 94) vs 1.28% (1 in 78) in the interventional group (OR 0.1614, 95% CI: 0.0194 to 1.3416, P= 0.0914). Adverse events (nausea, vomiting & loose stools) were observed in a total of 24 study patients, but necessitated withdrawal of regimen only in nine patients. Conclusion An SDD regimen of Colistin alone in Cardiac Surgery patients resulted in statistically significant reduction in incidence of Hospital Acquired Pneumonia, along with a reduction in all-cause mortality (though not statistically significant). Disclosures All Authors: No reported disclosures

A Research Protocol to Evaluate the Efficacy of Powerball versus Mulligan Mobilization with Movement on Pain and Function in Patients with Lateral Epicondylitis

Background: Amongst the most frequently repeated stress conditions within the elbow joint includes lateral epicondylitis (LE). The extensor carpi radialis brevis muscle attachment is affected mostly. The management of an individual with LE that manifests itself in repetitive upper extremity motions is the purpose of this research. There seems to be no study on the effects of PowerBall device training on the pain and function in individuals with Lateral Epicondylitis. “PowerBall device” practice is a type of strength training. Methods / Design: After conducting initial evaluations and allocation, the subjects (n=50) with LE will be involved in a randomized controlled study and classified either in an intervention group or a conventional group. The interventional group will do “PowerBall device” exercises, while others in the control group, doing MMWM. These groups will receive basic movements and ultrasound in accordance with the procedures. Discussion: The PRTEE scale measured the intervention's impact on pain and function in patients with LE, and a Hand-held Dynamometer was utilized to quantify grip strength. The findings will give considerable support for the use of the "PowerBall device" exercise and MMWM on LE patients. Conclusion: Conclusion will be drawn post study so as to see whether PowerBall device is more helpful or Mulligan Mobilization with Movement on pain and function in patients with LE. This study will give better approach to the therapist in managing the condition.

Hysteroscopic management of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Background Long-term complaints after caesarean section, such as postmenstrual spotting, dysmenorrhea, dyspareunia, or chronic pelvic pain, are frequently described in relation to the presence of a niche. A post-caesarean niche is defined as an indentation in the myometrium at the site of the uterine scar. Two independent prospective cohort studies reported that the presence of a niche after caesarean section increases the risk of postmenstrual spotting for more than 2 days from 15 to 30%. Postmenstrual spotting may be caused by a mechanical outflow problem, with the retention of menstrual blood in a niche, or by the accumulation of blood because of impaired uterine contractions at the site of the niche. Additionally, newly formed fragile vessels in the niche may play a role in the formation of blood or fluid in the niche and uterine cavity. Objective The aim of this study was to compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. Methods This trial is a randomised controlled trial that provides evidence for the (cost) effectiveness of hysteroscopic resection of a niche versus expectant management in women with niche related postmenstrual spotting. It was carried out on 28 cases divided into two equal group. The study was conducted at Ain Shams University on the women reporting postmenstrual spotting after a caesarean section. The primary outcome was the number of days of postmenstrual spotting 6 months after randomization. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, quality of life, women’s satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, also at 6 months after randomization. Results The results of this study show a significant improvement in interventional group after 3 months more than the control group in bleeding micturition characteristics which includes total days of spotting, spotting end of menstruation, intermenstral spotting, discomfort from spotting, dysmenorrhea and daily pain during micturition, after 6 months the two group improved but the interventional group was significantly higher than control group. Regarding the radiological assessment it was found that there was a significant improvement in intervention group more than the control group after 3 months, also the control group improved after 6 months also, but the intervention groups was significantly higher than the control group. The quality of life show a significant increasing in intervention group more than the control group after 3 months of intervention, at the end of follow up the intervention group was significantly higher in quality of life more than the control group. Conclusion A hysteroscopic niche resection reduces postmenstrual spotting, and the discomfort from spotting, compared with expectant management after 3 months of follow-up in women with a niche with a residual myometrium of at least 3 mm.

INTERVENTION OF CLINICAL PHARMACIST IN THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN OUTPATIENTS

Objective: The purpose of the study was to analyze the effect of clinical pharmacist intervention on glycemic control based on fasting blood glucose and glycosylated blood glucose level. Methods: A randomized prospective interventional study was conducted in the outpatient department of a tertiary care hospital. Patients suffering from diabetes for a least 2 y were selected for the study based on the inclusion and exclusion criteria. The control group was not given any special pharmacist care, while the interventional group had a face-to-face interview, counseling, and telephonic follow-up during the study period. Based on the baseline values and endpoint parametric values, the result of the study was analyzed. Results: The study was analyzed based on the difference in the glycemic index, using HbA1c and FBS values. The basal values of HbA1c were similar for both groups (8.5%), but a marked reduction to 7.2% was observed in the interventional group. FBS values reduced from 208 mg/dl to 186 mg/dl in the intervention group, while in the usual care group, the reduction was from 211 mg/dl to 198 mg/dl. Conclusion: The inclusion of clinical pharmacists in the healthcare team can offer a remarkable improvement in patient's condition by providing more support in the therapy.

Prospective Study to Evaluate Effect of Autologus Plasma Injection in the Wound Site immediately after Primary Wound Closure on Wound Healing

Corresponding Background Wound healing Process and Scars are still a nightmare for the surgeon and the author: patient as well, because of the large number and wide variability of factors affecting the process itself. Plasma injection is a very promising futuristic therapy and can be superior to PRP injection having more abundant growth factors, fibrin and healing promoters. Aim of the Work to evaluate the effect of injection of the whole plasma components in the wound site intradermally immediately after primary wound closure on the process of wound healing. Patients and Methods This prospective co-operative study included 20 patients having wounds in different sites of the abdomen after approval of research ethical committee of the Faculty of Medicine, Ain Shams University at July 2018, The patients are divided into two groups: an interventional group (group A) 10 cases which are received plasma treatment together with the usual wound care, and a control group (group B) 10 cases which are received the usual wound care only without plasma treatment, in the period between August 2018 to March 2019. Results We have found a faster wound healing process, higher cosmetic results, better color match, more patients' satisfaction and lower susceptibility to complications in the interventional group (A) that received plasma injection than in the control group (B) which received only the usual wound care without plasma injection reflecting the positive impact of plasma injection on the wound healing process. Conclusion We concluded that there are reasonable amount of data that warrant continued research and usage of plasma in the process of wound healing.

Effect of Spiritual Care on Death Anxiety and Self-esteem in Patients With Multiple Sclerosis

Introduction: Death anxiety and low self-esteem are major problems in patients with Multiple Sclerosis (MS). Spiritual interventions, along with other nursing interventions, can restore the balance between body and soul. Objective: This study aimed to determine the effect of the spiritual care program on death anxiety and self-esteem in MS patients. Materials and Methods: In this clinical trial, 60 patients with MS were randomly assigned into the intervention (n=30) and control (n=30) groups. The intervention group received spiritual care program in four sessions. Templer death anxiety and Rosenberg self-esteem scale were completed by samples before and after the intervention. Data analysis was performed using the independent t test, Chi-square, and Fisher exact tests. The significance level is considered less than 0.05. Results: The Mean±SD ages of the intervention and control group samples were 32.8±6.39 and 35.1±8.35 years, respectively. The Mean±SD scores of death anxiety in the control group 12.27±0.85 and the intervention group 11.8±0.88 before the intervention were not significantly different. After the intervention, the difference between the Mean±SD scores of the control group 12.10±0.61 and the interventional group 8.13±0.71 was statistically significant (P=0.001). The Mean±SD scores of self-esteem in the control group 14.63±1.51 and the interventional group 15.5±1.5 before the intervention were not significantly different. The difference between the Mean±SD scores of self-esteem in the control group 14.67±1.9 and the interventional group 18.03±1.85 was significant after the intervention (P=0.001). The results of ANCOVA demonstrated a significant difference between the control and intervention groups in terms of death anxiety (F=6.41, P=0.014, partial Eta2=0.101) and self-esteem (F=13.079, P=0.001, partial Eta2=0.187) of MS patients. Conclusion: Since spiritual care intervention in patients with MS reduced their death anxiety and increased their self-esteem, this simple and low-cost care program can be recommended for those suffering from this disease.