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Ying Y, Ji Y, Kong F, Chen Q, Lv Y, Hou Y, Zhu L, Miao P, Yu L, Li L, Kuang W, Jiang L, Zhu X, Liu X, Xu L, Mi Y, Lou Z, Ruan L. Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study. Internet Interv 2021; 26:100461. [PMID: 34631432 PMCID: PMC8487764 DOI: 10.1016/j.invent.2021.100461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a detrimental effect on the mental health of older adults living in nursing homes. Very few studies have examined the effects of Internet-based Cognitive Behavioral Therapy (ICBT) on older adults living in nursing homes during the pandemic. We conducted a feasibility study using a single-group design, to explore the effectiveness of ICBT on psychological distress in 137 older adults (without cognitive impairment) from 8 nursing homes in 4 southeast cities in China, between January and March 2020. METHODS Symptoms of depression, anxiety, general psychological distress, and functional disability were measured at baseline, post-treatment (5 weeks) and at a 1-month follow-up. Mixed-effects model was used to assess the effects of ICBT. RESULTS Statistically significant changes with large effect sizes were observed from pre- to post-treatment on the PHQ-9 (p < .001, Cohen's d = 1.74), GAD-7 (p < .001, d = 1.71), GDS (p < .001, d = 1.30), K-10 (p < .001, d = 1.93), and SDS (p < .001, d = 2.03). Furthermore, improvements in treatment outcomes were sustained at 1-month follow-up, and high levels of adherence and satisfaction were indicated. CONCLUSION ICBT was effective in reducing psychological distress in older adults without cognitive impairments living in nursing homes during the COVID-19 pandemic. Thus, it could be applied in improving the mental health of this vulnerable group during the pandemic.
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Key Words
- CBT, cognitive behavioral therapy
- CIs, confidence intervals
- COVID-19
- DSM-IV, The Diagnostic and Statistical Manual of Mental Disorders-4th edition
- Feasibility study
- GAD-7, Generalized Anxiety Disorder 7-item
- GDS, Geriatric Depression Scale
- ICBT, Internet-based cognitive behavioral therapy
- ITT, intention-to-treat
- Internet-based cognitive behavioral therapy
- K-10, 10-item Kessler Psychological Distress Scale
- LOCF, last observation carried forward
- MMRM, mixed-effects model for repeated measure
- Mental health
- Older adults
- PHQ-9, Patient Health Questionnaire 9-item
- Psychological distress
- RCT, randomized controlled trials
- REML, restricted maximum likelihood
- SD, standard deviation
- SDS, Sheehan Disability Scales
- UN, unstructured
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Affiliation(s)
- Yuchen Ying
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China
| | - Yunxin Ji
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
| | - Fanqian Kong
- Department of Medical Record and Statistics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China
| | - Qiqi Chen
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Yueer Lv
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Yanbin Hou
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
| | - Lijie Zhu
- Department of Statistics and Programming, Jiangsu Hengrui Pharmaceuticals Co. Ltd, Shanghai, PR China
| | - Pingping Miao
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
| | - Libo Yu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Laiyou Li
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Wei Kuang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Lingli Jiang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Xiaozhuo Zhu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Xiaozhuang Liu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Le Xu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China
| | - Yuwei Mi
- School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China
| | - Zhongze Lou
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
- Central Laboratory of the Medical Research Center, Ningbo First Hospital, Ningbo, Zhejiang, PR China
- Corresponding authors at: Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, 59 Liuting Street, Haishu District, Ningbo, Zhejiang 315211, PR China.
| | - Liemin Ruan
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
- Corresponding authors at: Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, 59 Liuting Street, Haishu District, Ningbo, Zhejiang 315211, PR China.
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Glinz D, Mc Cord KA, Moffa G, Aghlmandi S, Saccilotto R, Zeller A, Widmer AF, Bielicki J, Kronenberg A, Bucher HC. Antibiotic prescription monitoring and feedback in primary care in Switzerland: Design and rationale of a nationwide pragmatic randomized controlled trial. Contemp Clin Trials Commun 2021; 21:100712. [PMID: 33665467 PMCID: PMC7897989 DOI: 10.1016/j.conctc.2021.100712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Antibiotic consumption is highest in primary care, and antibiotic overuse furthers antimicrobial resistance. In our recently published pilot-RCT, we used monthly aggregated claims data to provide personalized antibiotic prescription feedback to general practitioners (GPs). The pilot-RCT has shown that personalized prescription feedback is a feasible and promising low-cost intervention to reduce antibiotic prescribing. Here, we describe the rationale and design of the follow-up RCT with 3426 GPs in Switzerland. We now have access to pseudonymized patient-level data from routinely collected health insurance data of the three largest health insurers in Switzerland. METHODS AND ANALYSIS 1713 GPs randomized to the intervention group received once evidence-based treatment guidelines at the beginning, including region-specific antibiotic resistance information from the community and personalized feedback of their antibiotic prescribing, followed by quarterly personalized prescription feedback for two years. The first and the last mailings were sent out in December 2017 and September 2019, respectively. The 1713 GPs randomized to the control group were not notified about the study and they received no guidelines and no prescription feedback. The personalized prescription feedbacks and the analyses of the primary and secondary outcomes are entirely based on pseudonymized patient-level data from routinely collected health insurance data. The primary outcome is prescribed antibiotics per 100 patient consultations during the second year of intervention. The secondary outcomes include antibiotic use during the entire two-year trial period, use of broad-spectrum antibiotics, hospitalization rates (all-cause and infection-related), and antibiotic use in different age groups. If the feedback intervention proves to be efficacious, the intervention could be continued systemwide. ETHICS AND DISSEMINATION The trial is publicly funded by the Swiss National Science Foundation (SNSF, grant number 407240_167066). The trial was approved by the ethics committee "Ethikkommission Nordwest-und Zentralschweiz" (EKNZ Project-ID 2017-00888). Results will be disseminated in peer-reviewed journals and international conferences.
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Key Words
- Antibiotics
- Antimicrobial resistance
- CI, confidence interval
- CONSORT, consolidated standards of reporting trials
- Claims
- DRG, Diagnosis Related Groups
- EKNZ, Ethikkommission Nordwest-und Zentralschweiz
- FMH, Foederatio Medicorum Helveticorum
- GP, general practitioners
- HRA, Human Research Act
- HRO, Human Research Ordinance
- Health-system level
- Hospitalization
- Low-cost intervention
- Prescription feedback
- Primary care
- RCT, randomized controlled trials
- Routinely collected patient data
- ZSR, Zentralregisternummer
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Affiliation(s)
- Dominik Glinz
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Kimberly A. Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ramon Saccilotto
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Andreas F. Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Julia Bielicki
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Switzerland
- St. George's University London, London, UK
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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Arasi S, Nurmatov U, Turner PJ, Ansotegui IJ, Daher S, Dunn-Galvin A, Ebisawa M, Eigenmann P, Fernandez-Rivas M, Gupta R, Nowak-Wegrzyn A, Petrou S, Roberts G, Sánchez Borges MA, Sindher SB, Tanno LK, Vazquez-Ortiz M, Vickery BP, Wong GWK, Fiocchi A. Consensus on DEfinition of Food Allergy SEverity (DEFASE): Protocol for a systematic review. World Allergy Organ J 2020; 13:100493. [PMID: 33376574 PMCID: PMC7753945 DOI: 10.1016/j.waojou.2020.100493] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background and aims The term “Food Allergy” refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. Methods We will undertake a systematic review, which will involve searching international biomedical databases for published studies. Studies will be independently screened against pre-defined eligibility criteria and critically appraised by established instruments. Data will be descriptively and, if possible and applicable, quantitatively synthesised. Ethics and dissemination This study does not require any specific ethical approval since it is a systematic review. We plan to report results from this systematic review in a peer reviewed journal. These results will be used to inform the development of an international consensus to define severe food allergy. Author's potential conflicts of interest are clearly stated. PROSPERO registration number CRD42020183103.
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Key Words
- CASP, Critical Appraisal Skills Programme
- CBA, controlled before after studies
- CCT, controlled clinical trials
- CHEERS, Consolidated Health Economic Evaluation Reporting Standards
- CI, confidential interval
- Classification
- Definition
- FAIM, food allergy independent measure
- FAQL, food allergy quality of life
- FARE, Food Allergy Research & Education
- Food allergy
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ITS, interrupted time series
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PROSPERO, Prospective Register of Systematic Reviews
- RCT, randomized controlled trials
- Severity
- WAO, World Allergy Organization
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Affiliation(s)
- Stefania Arasi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK.,Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia
| | | | - Shahd Daher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK
| | - Audrey Dunn-Galvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Philippe Eigenmann
- Pediatric Allergy Unit, Department of Women-Children-Teenagers Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Ruchi Gupta
- Center for Food Allergy and Asthma Research (CFAAR), Northwestern University Feinberg School of Medicine; Department of Pediatrics & Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, USA
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA.,Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, England, UK
| | - Graham Roberts
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - Mario A Sánchez Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Sayantani B Sindher
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.,Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil.,University Hospital of Montpellier; Sorbonne Universités, Paris, Montpellier, France
| | | | - Brian P Vickery
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Gary Wing-Kin Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Alessandro Fiocchi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Shimizu N, Kotani K. Point-of-care testing of (N-terminal pro) B-type natriuretic peptide for heart disease patients in home care and ambulatory care settings. Pract Lab Med 2020; 22:e00183. [PMID: 33134469 PMCID: PMC7585141 DOI: 10.1016/j.plabm.2020.e00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The role of point-of-care testing (POCT) out of hospital, especially in home care and ambulatory care settings, is an issue meriting further research. We reviewed studies reporting cardiovascular events as a result of the implementation of B-type natriuretic peptide or N-terminal pro B-type natriuretic peptide POCT (BNP/NT-proBNP POCT) for heart disease patients in the settings. Design Articles were searched via a PubMed engine until May 30, 2020. Results In total, six studies were selected. Three studies involving ambulatory care used the POCT to refer patients with suspected heart diseases to a specialist. The other three used the tests in home care to monitor patients with heart failure. In ambulatory care, the randomized controlled trials, in which referrals were made to a specialist, showed that the group using POCT had significantly fewer cardiovascular outcomes, such as hospitalizations and deaths, than the non-use group. In home care, adverse outcomes were predicted from changes in BNP levels. Conclusions In most studies, the use of BNP/NT-proBNP POCT in home care and ambulatory care settings demonstrated favorable results regarding the cardiovascular outcomes. The utility of POCT in the settings is suggested, while more investigations are required. Point-of-care testing of BNP can be useful for referral of patients to specialists as demonstrated in two randomized control trials. Point-of-care testing of BNP couldpredict acute heart failure as demonstrated in three observational studies. The findings should be generalized with care because of the limitation of available data.
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Key Words
- ADHF, acute clinical HF decompensation
- AUC, area under the curve
- BNP
- BNP, B-type natriuretic peptide
- HF, heart failure
- HFpEF, HF with preserved ejection fraction
- HFrEF, HF with reduced ejection fraction
- HR, hazard ratio
- Heart failure
- Home care
- IRR, incidence rate ratio
- MACE, major adverse cardiac events
- NT-proBNP
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- OR, odds ratio
- POCT, point-of-care testing
- Point-of-care testing
- Primary care
- RCT, randomized controlled trials
- Sn, sensitivity
- Sp, specificity
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Affiliation(s)
- Nayuta Shimizu
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Tochigi, Japan
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Al-Abdouh A, Khan SU, Barbarawi M, Upadhrasta S, Munira S, Bizanti A, Elias H, Jat A, Zhao D, Michos ED. Effects of Febuxostat on Mortality and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Mayo Clin Proc Innov Qual Outcomes 2020; 4:434-442. [PMID: 32793871 PMCID: PMC7411164 DOI: 10.1016/j.mayocpiqo.2020.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate the association between using febuxostat and cardiovascular events. Methods Systematic search of randomized controlled trials was performed using PubMed/MEDLINE, Cochrane review, and EMBASE databases through April 17, 2019. Meta-analysis was performed using random effect model and estimates were reported as risk difference (RD) with 95% CIs. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The main outcomes of interest were cardiovascular mortality and all-cause mortality. Results A total of 15 randomized controlled trials (16,070 participants) were included. The mean ± SD age was 58.1±11.7 years. At the median follow-up of 6.4 months, use of febuxostat was not associated with statistically significant risk of cardiovascular mortality (RD, 0.12%; 95% CI, -0.25% to 0.49%; I2=48%; low certainty evidence), all-cause mortality (RD, 0.20%; 95% CI, -0.28% to 0.68%; I2 =60%; very low certainty evidence), major adverse cardiovascular events (RD, 0.40%; 95% CI, -0.34% to 1.13%; I2=26%; low certainty evidence), myocardial infarction (RD, -0.06%; 95% CI, -0.29% to 0.17%; I2 =0%; moderate certainty evidence), stroke (RD, 0.10%; 95% CI, -0.15% to 0.35%; I2=0%; moderate certainty evidence), or new-onset hypertension (RD, 1.58%; 95% CI, -0.63% to 3.78%; I2=58%; very low certainty evidence). These findings were consistent in patients with existing cardiovascular disease. Conclusion This meta-analysis suggested that use of febuxostat was not associated with higher risk of mortality or adverse cardiovascular outcomes in patients with gout and hyperuricemia. The results were limited by low to moderate certainty of evidence.
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Affiliation(s)
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV
| | | | | | - Srajum Munira
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD
| | - Anas Bizanti
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD
| | - Hadi Elias
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD
| | - Asadulla Jat
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD
| | - Di Zhao
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD.,Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Chotchoungchatchai S, Krairit O, Tragulpiankit P, Prathanturarug S. The efficacy of honey and a Thai Herbal Oil preparation in the treatment of pressure ulcers based on Thai traditional medicine wound diagnosis versus standard practice: An open-label randomized controlled trial. Contemp Clin Trials Commun 2020; 17:100538. [PMID: 32072072 PMCID: PMC7013157 DOI: 10.1016/j.conctc.2020.100538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/11/2020] [Accepted: 01/26/2020] [Indexed: 01/17/2023] Open
Abstract
Background Scientific support for Thai traditional medicine (TTM) practice is warranted for reintroduction into modern healthcare systems. A promising TTM practice for treatment of pressure ulcers was selected to conduct a clinical trial. This study aimed to evaluate the efficacy of the TTM practice for the treatment of pressure ulcers using honey or a Thai Herbal Oil preparation (THO) based on the TTM wound diagnosis comparing with the standard practice. Methods The study design was an open-label randomized controlled trial. Sixty-six participants, with pressure ulcers at least stage II-IV or unstageable, were allocated to two groups via minimization. A TTM practice group received honey or THO depending on the TTM diagnosis via the Thai Traditional Medicine Pressure Ulcer Assessment Tool (TTM-PUAT). A standard practice group received advanced dressings, including hydrogel, alginate, silver-impregnated, or hydrocolloid dressings. The primary outcome was the Pressure Ulcer Scale for Healing (PUSH). Results Both TTM practice and standard practice showed a significant reduction in PUSH scores after treatments. However, there was no significant difference in PUSH score reduction between the groups. The mean PUSH score reduction over the 6-week period was 2.58 ± 3.38 (95% CI 1.34-3.82) in the TTM practice group and 3.24 ± 3.49 (95% CI 1.91-4.57) in the standard practice group (p = 0.284). The TTM practice and standard practice accelerated pressure ulcer healing without statistically significant difference between the practices, during 6 weeks in a home-based care setting. This finding supported the TTM practice as an alternative treatment for pressure ulcer.
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Key Words
- BWAT, Bates-Jensen Wound Assessment Tool
- Clinacanthus nutans
- Decubitus
- Diagnosis
- Honey
- ITT, intention-to-treat
- NPUAP / EPUAP, National Pressure Ulcer Advisory Panel and the European Pressure Ulcer Advisory Panel
- PP, per-protocol
- PU, pressure ulcer
- PUSH, Pressure Ulcer Scale for Healing
- RCT, randomized controlled trials
- TAMC, total aerobic microbial count
- THO, Thai Herbal Oil preparation
- TLC, thin layer chromatography
- TTM, Thai traditional medicine
- TTM-PUAT, Thai Traditional Medicine Pressure Ulcer Assessment Tool
- TYMC, total combined yeasts and molds count
- Traditional medicine
- Zingiber montanum
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Affiliation(s)
| | - Orapitchaya Krairit
- Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sompop Prathanturarug
- Department of Pharmaceutical Botany, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
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Abstract
PURPOSE The Middle East and North Africa (MENA) region registers some of the lowest serum 25‑hydroxyvitamin D [25(OH)D] concentrations, worldwide. We describe the prevalence and the risk factors for hypovitaminosis D, completed and ongoing clinical trials, and available guidelines for vitamin D supplementation in this region. METHODS This review is an update of previous reviews published by our group in 2013 for observational studies, and in 2015 for randomized controlled trials (RCTs) from the region. We conducted a comprehensive search in Medline, PubMed, and Embase, and the Cochrane Library, using MeSH terms and keywords relevant to vitamin D, vitamin D deficiency, and the MENA region, for the period 2012-2017 for observational studies, and 2015-2017 for RCTs. We included large cross-sectional studies with at least 100 subjects/study, and RCTs with at least 50 participants per arm. RESULTS We identified 41 observational studies. The prevalence of hypovitaminosis D, defined as a 25‑hydroxyvitamin D [25(OH)D] level below the desirable level of 20 ng/ml, ranged between 12-96% in children and adolescents, and 54-90% in pregnant women. In adults, it ranged between 44 and 96%, and the mean 25(OH)D varied between 11 and 20 ng/ml. In general, significant predictors of low 25(OH)D levels were female gender, increasing age and body mass index, veiling, winter season, use of sun screens, lower socioeconomic status, and higher latitude.We retrieved 14 RCTs comparing supplementation to control or placebo, published during the period 2015-2017: 2 in children, 8 in adults, and 4 in pregnant women. In children and adolescents, a vitamin D dose of 1000-2000 IU/d was needed to maintain serum 25(OH)D level at target. In adults and pregnant women, the increment in 25(OH)D level was inversely proportional to the dose, ranging between 0.9 and 3 ng/ml per 100 IU/d for doses ≤2000 IU/d, and between 0.1 and 0.6 ng/ml per 100 IU/d for doses ≥3000 IU/d. While the effect of vitamin D supplementation on glycemic indices is still controversial in adults, vitamin D supplementation may be protective against gestational diabetes mellitus in pregnant women. In the only identified study in the elderly, there was no significant difference between 600 IU/day and 3750 IU/day doses on bone mineral density. We did not identify any fracture studies.The available vitamin D guidelines in the region are based on expert opinion, with recommended doses between 400 and 2000 IU/d, depending on the age category, and country. CONCLUSION Hypovitaminosis D is prevalent in the MENA region, and doses of 1000-2000 IU/d may be necessary to reach a desirable 25(OH)D level of 20 ng/ml. Studies assessing the effect of such doses of vitamin D on major outcomes, and confirming their long term safety, are needed.
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Key Words
- 25(OH)D, 25‑hydroxyvitamin D
- ALKP, alkaline phosphatase
- BMC, bone mineral content
- BMD, bone mineral density
- BMI, body mass index
- CARS, Childhood Autism Rating Scale
- CDC, Centers for Disease Control
- Ca, Calcium
- DEQAS, Vitamin D External Quality Assessment Scheme
- DXA, dual-energy X-ray absorptiometry
- ESCEO, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis
- GDM, Gestational Diabetes Mellitus
- HOMA-IR, homeostatic model assessment of insulin resistance
- HbA1c, glycated hemoglobin
- Hypovitaminosis D
- ID LC-MS/MS, isotope dilution liquid chromatography - tandem mass spectrometry
- IOM, Institute of Medicine
- KSA, Kingdom of Saudi Arabia
- LCMS/MS, liquid chromatography-tandem mass spectrometry
- MENA, Middle East North Africa
- Middle East and North Africa
- OSTEOS, Lebanese Society for Osteoporosis and Metabolic Bone Disorders
- PO4, phosphorus
- PTH, parathyroid hormone
- Predictors
- RCT, randomized controlled trials
- ROB, risk of bias
- RR, relative risk
- SDp, pooled standard deviation
- T2D, type 2 diabetes
- UAE, United Arab Emirates
- UVB, ultraviolet B
- VDDR2, vitamin d dependent rickets type 2
- VDR, vitamin d receptor
- VDSP, Vitamin D Standardization Program
- Vitamin D assays
- Vitamin D guidelines
- WM, weighted mean
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Affiliation(s)
- Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, P.O. Box: 113-6044/C8, Lebanon
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8
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Mugarab-Samedi V, Howlett A, Hicks M, Arrieta MC, Beaudry P, Dersch-Mills D, Alshaikh B. Probiotics supplementation and length of hospital stay in neonates with gastrointestinal surgery. Int J Surg Protoc 2017; 6:13-16. [PMID: 31851737 PMCID: PMC6913565 DOI: 10.1016/j.isjp.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022] Open
Abstract
Any manipulation on open bowel causes interventional impact on gut microbiome, and surgical stress triggers bacterial translocation; thus, it will be fundamental to determine gut microbiome after surgery. Monitoring dynamic changes in microbiome of post-surgical infants who received probiotics and placebo could provide with important information about gut colonization and potential bacterial overgrowth. The purpose of this study is to assess the effect of probiotics supplementation on length of hospital stay, duration of parenteral nutrition, and feed tolerance in neonates after gastrointestinal surgery.
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Affiliation(s)
| | - Alixe Howlett
- Department of pediatrics, University of Calgary, Calgary, Canada
| | - Mattew Hicks
- Department of pediatrics, University of Alberta, Edmonton, Canada
| | | | - Paul Beaudry
- Department of pediatrics, University of Calgary, Calgary, Canada
| | | | - Belal Alshaikh
- Department of pediatrics, University of Calgary, Calgary, Canada
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9
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Van Norman GA. Overcoming the Declining Trends in Innovation and Investment in Cardiovascular Therapeutics: Beyond EROOM's Law. JACC Basic Transl Sci 2017; 2:613-625. [PMID: 30062175 PMCID: PMC6058942 DOI: 10.1016/j.jacbts.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/11/2022]
Abstract
Eroom's law (Moore's law spelled backwards), describes adverse trends towards declining innovation and rising costs of drug development over the last several decades. Therapeutics for cardiovascular diseases (CVD) appear to have been particularly sensitive to these trends. Thirty-three percent fewer CVD therapeutics were approved between 2000 and 2009 compared to the previous decade, and the number of CVD drugs starting all clinical trial stages declined in both absolute and relative numbers between 1990 and 2012. In the last 5 years, drugs to treat CVD disease comprised just 6% of all new drug launches. This review discusses the decline in CVD therapeutics, the reasons behind it, and ways in which this trend is being or might be addressed.
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Key Words
- CVD, cardiovascular disease
- Eroom’s law
- FDA, Food and Drug Administration
- NIH, National Institutes of Health
- OD, orphan drug
- PPMD, parent project muscular dystrophy
- R&D, research and development
- RCT, randomized controlled trials
- ROI, return on investment
- SDLT, severely debilitating or life-threatening
- TB, tuberculosis
- drug approval
- innovation
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Affiliation(s)
- Gail A. Van Norman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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