The Transitions to Long-term In Home Ventilator Engagement Study (Transitions to LIVE): study protocol for a pragmatic randomized controlled trial
Reshma AminAndrea S. GershonFrancine BuchananRegina PizzutiAdam QaziNishali PatelRuxandra PintoMyla E. MorettiMunazzah AmbreenPaula AbelhaAdele BakerR. Sacha BhatiaCindy BrennanJulia BokhautJackie ChiangNisha CithiravelJana CollinsDaniel Cornejo PalmaL. S. CostaKatie N. DaintyRefika ErsuTom FisherErin FleischerSandy FodeyIan FraserRoger GoldsteinJ.M HyattAshley InmanMary IrvenJoanna JanevskRaj KohliSherri L. KatzWilma J. KoopmanSarah KuyntjesDavid LeasaAudrey LimPaty Sala LopezDenise Maria MartinsCathy MawdsleySandra McKayDoug McKimKristin McMillanR. A. McNayKevan MehtaR. MossJ M NaylorMika NonoyamaMichelle OverholtApril PriceJ.A. RoyMadan Roy Christen ShoesmithAman SidhuJoanne SmithLisa SpoonerAaron St‐LaurentFaiza SyedAnu TandonMark S. ThompsonBrenda ToondersTuyen Quang TranMelissa TrinhRobert VaradiShannon L. VenanceKevin WorkentinAllison ZweerinkLouise Rose
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We co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material.Our primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children's Hospital Eastern Ontario, McMaster Children's Hospital, Children's Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital.This pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention.ClinicalTrials.gov NCT04180722 . Registered on November 27, 2019.Emergency department (ED) utilization for non-emergent conditions is costly and inefficient. We evaluated whether a simple office-based intervention could encourage patients with non-emergent conditions to be seen in the office instead of in the ED. The study compared ED utilization of patients of the intervention family medicine clinic to those of the nearby internal medicine clinic. The intervention consisted of educational posters in the family medicine clinic and follow-up letters after non-emergent ED visits. We measured ED use for the two clinics before, during, and after the intervention. We found a statistically significant decrease in ED utilization for the patients of the intervention clinic. For the intervention office with approximately 1100 patient encounters per month, this resulted in a reduction of approximately 40 ED visits per month. If these results are replicated, this simple intervention could result in cost savings and more efficient patient care.
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Background: Although lung ultrasound (LUS) has been widely used in the critical care setting, its applications in perioperative management of different lung pathologies are still limited.Objective: This randomized controlled study aimed to evaluate the benefits of perioperative LUS followed by LUS-guided recruitment maneuver in adults undergoing open heart surgery.Methods: One hundred patients admitted for elective cardiac surgery were enrolled in this trial.They were divided into two groups; the control group (Group C) included 50 patients who underwent LUS without LUS guided interventions, and LUS group (Group L) included the remaining patients who underwent LUS followed by LUS-guided recruitment maneuver and other interventions according to the finding.Results: Baseline characteristics of the study population and perioperative variables showed no significant difference between the study groups.Postoperative pulmonary complications tended to be significantly higher in Group C (22% versus 6% in Group Lp = 0.021).the incidence of postoperative desaturation was significantly higher in the control group than in the intervention group.However, the incidence of intraoperative desaturation was similar between the control and intervention groups.Better aeration, B-line, and compliance scores were detected when LUS-guided recruitment was applied.Additionally, Group L expressed higher O2 saturation in most of the recorded readings.There was a significant decline in the duration of postoperative mechanical ventilation and the need for respiratory support LUS-guided recruitment was applied.Conclusions: Postoperative pulmonary outcomes showed a significant improvement in association with LUS-guided recruitment maneuvers and other interventions after adult cardiac surgery.
Lung Ultrasound
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Objective To explore the influence of individualized nursing intervention on life quality of patients with rheumatoid arthritis. Methods 60 patients were divided into the intervention group and the control group with 30 cases in each group. The intervention group adopted individualized nursing projects according to the influencing factors of life quality based on routine nursing. The control group received routine nursing only. The life quality of the two groups was appraised by inventory before and after intervention. Results The status such as physiological function, mental function, social function and self-recognized health in the intervention group was greatly ameliorated and was statistically different from that in the control group(P＜0.05).Conclusion Individualized nursing intervention could dramatically improve the life quality of patients with rheumatoid arthritis
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Rheumatoid arthritis; Life quality; Nursing
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Rujirojindakul, P.; Liabsuetrakul, T.; McNeil, E.; Chanchayanon, T.; Rergkliang, C. Author Information
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Background: Upper abdominal surgeries have been reported to be associated with an increased incidence of postoperative atelectasis.Preventing atelectasis is important for all patients but is more important when caring for obese patients.Objectives: To determine which of the following ventilatory strategies is better in prevention of pulmonary atelectasis in obese patients undergoing non-bariatric surgery: Volume control ventilation "VC", Pressure control Ventilation "PC", Volume control ventilation + Positive End Expiratory Pressure "PEEP", Volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver.Patients and methods: A randomized-controlled trial study was carried out in the operating room (OR) in Zagazig University Hospital including 92 patients.Patients were randomly allocated into four groups.G1: Volume control ventilation "VC", G2: Pressure control Ventilation "PC", G3: Volume control ventilation + Positive End Expiratory Pressure "PEEP", G4: as in G3 + lung recruitment maneuver.Results: There was significant difference between the studied groups as regards PaO 2 /FiO 2 ratio as the 4 th group was highly significant.There was also significant difference between the studied groups as regards atelectasis score with the least atelectasis score in group 4.There was a significant difference in group 4 than the other groups as regards length of stay in PACU, and need for 100% Fio2 in PACU.Finally, there was a significant difference between the studied groups as regards postoperative pulmonary complications with the 4 th group has the least postoperative complication. Conclusion:Our results suggest that volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver had beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post-operative period in obese patients undergoing non-bariatric upper abdominal surgeries.
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Intervention using a real-time database system was accepted by physicians and reduced high-cost encounters. The risk of a high-cost encounter was significantly greater for the minimal intervention than for the moderate or maximal intervention groups. The probability of an emergency department visit was significantly reduced for minimal compared with moderate and maximal intervention. The risk for emergency department events was the same for the moderate and maximal intervention groups. Moderate intervention seems the most cost-effective because of reductions achieved with minimal staff involvement.
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Background: caesarean sections performed every year are increasing in number dramatically all over the world.So, it became very important to give more attention for their postoperative care.Aim of the Work: to evaluate the effect of immediate oral hydration initiated within 2 hours after uncomplicated caesarean section on the following post-operative outcomes: post-operative vomiting and abdominal distention, post-operative nausea and abdominal pain, the return of intestinal movements, duration of intravenous fluid administration, duration of hospital stay and participant satisfaction.Patients and Methods: this randomized controlled study was conducted at Ain Shams University Maternity Hospital.It was carried during the period from July 2016 to July 2017.140 women, all of them underwent uncomplicated cesarean section under regional anesthesia were randomly assigned into two groups.In the immediate group: oral hydration was received in the first 2 hours postoperatively, and in the early group: oral hydration was received after 8 hours postoperatively.Results: all the results of the postoperative outcomes of both groups had non-significant differences except for the psychological satisfaction which was significantly higher in the immediate group with a (p<0.001).Conclusion: immediate oral hydration group showed non-significant differences comparing with early oral hydration group regarding most of the postoperative outcomes, but the results were relatively better towards the immediate group.Also, immediate hydration is significantly better than early hydration regarding psychological satisfaction of women, allowing them to be more able to breastfeed their kids and to spend a less stressful time in the hospital.
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