Early Intervention Group Research Articles

Early versus Delayed Invasive Intervention in NSTE-ACS: Clinical Outcomes

Abstract Background: The aim of this study was to compare an early versus a delayed invasive strategy in NSTE-ACS prospectively. Methods: Prospective observational study including patients admitted for NSTE-ACS requiring an invasive management. The primary endpoint was the occurrence of MACCE (death, new myocardial infarction or stroke) at 30-days and 1-year follow-up. Results: 167 patients in the early-intervention group (within 24 hours, n = 167) and 129 patients in the delayed-intervention group (24 to 72 hours, n = 129). There was no difference in the primary endpoint of 30-days MACCE (4.2% vs. 6.2%; p = 0.25) and 1-year MACCE (10.2% vs. 17.1%; p = 0.34). Conclusions: An early invasive strategy does not reduce the risk of death or MACCE compared with a delayed strategy.

Early intervention for psychosomatic symptoms of adolescents in school checkup.

The purpose of this study was to evaluate the efficacy of early medical intervention for psychosocial problems detected in adolescents in a school health checkup, with the broader goal of prevention of these problems in adolescents. The Questionnaire for Triage and Assessment with 30 items score and scores for five subscales (physical symptoms, depression symptoms, anxiety symptoms, self-efficacy, and family function), and an investigation of lifestyle were determined in a school health checkup for 5th grade elementary to 3rd grade junior high school students. Forty-three children were found to be at high risk for psychosomatic disorder, of whom 18 then received a medical intervention (early intervention group) and 25 did not (non-intervention group). Fifty-seven children (outpatient group) treated for psychosomatic disorder for ≤3 months were also included in the study. The Questionnaire for Triage and Assessment with 30 items (QTA30) was completed by all participants every 3 months for 1 year and scores were compared among the groups. In the early intervention group, total Questionnaire for Triage and Assessment with 30 items scores; physical, depression, and anxiety symptoms; and unstable relationships with friends and teachers at school all significantly improved after 1 year compared to the first survey. None of these items improved in the non-intervention group, while the outpatient group had gradual improvement in all scores. Family function scores in the early intervention group improved over time, whereas those in the non-intervention group worsened. Early detection of children at high risk for psychosomatic disorder at a school health checkup and early medical intervention were useful for prevention of psychosomatic disorder in adolescents.

Outcomes in patients with systemic sclerosis undergoing early vs delayed intervention with potential disease-modifying therapies.

To examine whether early therapeutic intervention, compared with delayed intervention, is beneficial for patients with early SSc. This is a single-centre, retrospective cohort study of SSc patients who received CYC, MMF, MTX or tocilizumab for diffuse cutaneous SSc (dcSSc) or interstitial lung disease (ILD) within 6 years after disease onset. The patients were divided into early and delayed intervention groups based on the disease duration of ≤18 and >18 months at treatment introduction, respectively. Clinical worsening was defined as the development of any original or revised ACR Composite Response Index in SSc (CRISS) step 1 event or progressive fibrosing ILD (PF-ILD). There was no difference in baseline characteristics between the early (n = 25) and delayed (n = 21) intervention groups except forced vital capacity, which was better in the early vs delayed intervention groups. The early intervention group less frequently had stable pulmonary function over 1 year than did the late intervention group (odds ratio 0.087, 95% CI: 0.0079, 0.51; P = 0.003). The active disease was significantly decreased from 79% to 42% in the early intervention group (P = 0.007), but the change in the delayed intervention group was not statistically significant (68% to 42%; P = 0.11). Cumulative rates free from clinical worsening events defined by revised ACR-CRISS and PF-ILD were significantly higher in the early vs delayed intervention groups (P = 0.03 and 0.003, respectively). A therapeutic 'window of opportunity' might exist in SSc patients.

Early versus Delayed Implant Exchange after Periprosthetic Breast Infection: A Single Center Study.

Background:Breast implant infections are challenging problems for both plastic surgeons and patients. They may require readmissions, re-operations, and have the potential to compromise the final result. Our goal was to determine whether early operative intervention (return to the operating room <72 h after diagnosis of infection) or intravenous antibiotics with later operative intervention increased long-term retention of a prosthesis.Methods:A retrospective review was conducted of patients who were hospitalized or underwent reoperation for an infection from 2006 through 2016. The length of hospitalization, length of IV antibiotic use, and retention of the breast prosthesis at 3-months after reoperation were recorded for each patient.Results:A total of 43 patients were included in our study. Of these, 33 patients underwent early intervention, and 10 patients underwent delayed intervention. The average length of stay was significantly shorter in the early versus delayed return to OR group (4.1 versus 6.4 days; P = 0.008). The average duration of antibiotics was shorter in the early intervention group than the delayed group (5.1 versus 6.4 days; P = 0.28). At 3-months postoperatively, a greater proportion of patients in the early intervention group compared with the delayed group retained their breast prostheses (87.5% versus 60%; P = 0.25).Conclusions:The results of this study demonstrate that breast implants may be salvaged after early (<72 hours) or delayed (>72 hours) operative intervention; however, early intervention is associated with a significantly shorter length of stay, and trends toward a shorter antibiotic course and higher rate of implant retention at 3 months.

Parent perceptions of minimally invasive dental treatment of Australian Aboriginal pre-school children in rural and remote communities.

Aboriginal* children in rural and remote communities in Australia have a higher burden of dental decay and poorer access to dental services than their non-Aboriginal counterparts. In the Kimberley region of Western Australia (WA), Aboriginal children experience six times the rate of untreated dental decay of non-Aboriginal children. Access to dental care is challenged by the availability and appropriate delivery of services in remote locations. This study elicited the experiences and perceptions of parents and carers who participated in a project that tested the minimally invasive atraumatic restorative treatment and the Hall technique approaches (ART-HT) to manage early childhood dental caries among Australian Aboriginal preschool children. The core study design was a stepped-wedge, cluster-community-randomised controlled trial. Consenting communities in the Kimberley region of WA were randomised into early and delayed intervention groups. Children were clinically examined at study commencement; the early intervention group was offered dental treatment using the ART-HT approach, and the delayed group was advised to seek dental care from their usual service provider. At the 12-month follow-up, children in both groups were re-examined and offered care using the minimally invasive model of care, and parents and carers were invited to take part in focus group or one-to-one interviews. Semistructured interviews, guided by the yarning approach, were conducted with consenting parents and carers in community locations of convenience to participants. The same open-ended questions were asked of all participants, and the interviews were audio-recorded with permission and transcribed by an independent agency. Thematic analysis was undertaken, the transcripts were coded by NVivo software, and emergent themes were identified and developed. One-to-one interviews were conducted with 29 parents and carers (10 from five test communities; 19 from eight control communities). Interview participants consisted of 3 males and 26 females. Following thematic analysis, three main themes (and subthemes) were identified: (1) access to care (barriers, service availability, impact on family due to lack of access); (2) experience of care (cultural safety, child-centred care, comprehensiveness of care); (3) community engagement (service information, engagement, oral health education). Structural and system factors as well as geography were identified as barriers by parents and carers in accessing timely and affordable dental care in culturally safe environments; parents and carers also identified the impacts from lack of access to care. They valued comprehensive care delivered within community, underpinned by child- and family-centred care. Of equal importance was the holistic approach adopted through the building of community engagement and trusting relationships. A high level of satisfaction was reported by parents and carers with their experience of dental care for their children with the minimally invasive approach. Satisfaction was expressed around ease of accessing services delivered in a child- and family-centred manner, and that were well supported by appropriate engagement between service providers, communities and families. The findings from this study suggest a minimally invasive dental care model can be considered effective and culturally acceptable and should be considered in delivering oral health services for young children in rural and remote locations. * The term Aboriginal is inclusive of Aboriginal and Torres Strait Islander peoples.

Effects of early rehabilitation in improvement of paediatric burnt hands function.

BACKGROUNDHands are one of the most common burn sites in children. Hypertrophic scar contractures in hands after wound healing result in further reductions in their range of motion (ROM), motility, and fine motor activities. Rehabilitation can improve the function of hands. But the optimal time of rehabilitation intervention is still unclear. Therefore, this study was designed to investigate the effects of early rehabilitation management of paediatric burnt hands and to compare the efficacy between early and later rehabilitation intervention.AIMTo investigate the effects of early rehabilitation management of paediatric burnt hands. METHODSA total of 52 children with burnt hands were allocated into the early intervention group (≤ 1 mo from onset) and a late intervention group (> 1 mo from onset) between January 2016 and December 2017. The children received the same rehabilitation programme including skin care, scar massage, passive ROM exercises, active ROM exercises, compression therapy, orthotic devices wearing and game or music therapy. Rehabilitation assessments were performed before and after the rehabilitation treatment.RESULTSIn the early intervention group, the ROM of the hands was significantly improved after rehabilitation (P = 0.001). But in the late group the effect was not significant statistically (P = 0.142). In the early group, 38.5% of the patients showed significant improvement, while in the late group, 69.2% of the patients showed no significant improvement. The time from onset to posttraumatic rehabilitation (P = 0.0007) and length of hospital stay (P = 0.003) were negatively correlated with the hand function improvement. The length of rehabilitation stay was positively correlated with the hand function improvement (P = 0.005). CONCLUSIONThese findings suggest that early rehabilitation might show better results in terms of ROM.

Impact of Early Surgical Intervention of Plastic Surgeons on the Prognosis of Necrotizing Soft Tissue Infection.

BackgroundNecrotizing soft tissue infection (NSTI) is a rare, severe bacterial infection that causes rapidly progressive soft tissue necrosis from the skin to the muscle. The gold standard for treating NSTI is a prompt diagnosis, early surgical debridement of necrotic tissue, and antimicrobial therapy. This study investigated the relationship between the involvement of plastic surgeons and the clinical course of NSTI cases treated at Yokosuka General Hospital Uwamachi.MethodologyThis study involved 28 patients with NSTI who were treated at Yokosuka General Hospital Uwamachi. Patient background, outcomes (mortality and amputation), and days to the first surgery were compared in the early and nonearly plastic surgery intervention groups. Moreover, the duration of treatment was also compared in surviving patients. Differences between the two groups were analyzed using Fisher’s direct probability test, Mann-Whitney U test was used for comparison of continuous variables between the two groups, and Spearman’s rank correlation analysis was used for the bivariate correlation coefficient. The significance level was set at <5%.ResultsThere were eight and 20 patients in the early and nonearly plastic surgery intervention groups (14 in later intervention and six in nonintervention), respectively. A difference in the median number of days to the first surgery between the early (zero days) and the nonearly (two days) intervention groups was significant (p = 0.002). In the survival groups, the median treatment duration in the early (n = 8) and nonearly (n = 13) intervention groups was 44 and 82 days, respectively, which was significantly shorter in the early intervention group (p = 0.003).ConclusionsThe number of days until the first surgery and the length of the treatment period were significantly shorter in the early plastic surgery intervention group than in the nonearly intervention group.

Unfinished business: Functional outcomes in a randomized controlled trial of a three-year extension of early intervention versus regular care following two years of early intervention for psychosis.

To investigate whether first-episode psychosis patients receiving extended early intervention had better functional outcomes than those in regular care and to examine the predictors of functional outcomes. This is a randomized controlled single-blind trial of220patients randomizedafter 2years of early intervention to receive early intervention or regular care for the subsequent 3years. Outcomes included cumulative time in functional recovery during the 3-year trial assessed using the Social and Occupational Functioning Assessment Scale (SOFAS); and employment/education at last assessment which were, respectively, analyzed using multiple linear regression and logistic regression, accounting for well-known predictors. Linear mixed and generalized linear models were also used to examine the course of SOFAS and employment/education over the 3-year period. The extended early intervention and regular care groups did not differ on time in functional recovery (mean=50.17weeks, SD=46.62 vs. mean=46.18weeks, SD=51.54); percent employed/in school (60.4% vs. 68.8%) or change in SOFAS or employment/education status over time. SOFAS scores were stable between years 2 and 5. Individuals with longer periods of total symptom remission experienced significantly longer periods of functional recovery and were likelier to be employed/in school. Those who had completed high school were nine times likelier to be employed/studying. Most individuals maintained functional gains accrued from 2years of early intervention with no further improvement whether in extended early intervention or regular care. There was a gap between symptomatic and functional recovery, and one-third were unemployed/not in school at year 5. The lack of additional progress even in extended early intervention suggests that specific interventions addressing functional roles need to be provided beyond the first 2years of early intervention. Sustaining symptom remission and high-school completion may be additional avenues for targeting functional recovery.

OPTIMISE: a pragmatic stepped wedge cluster randomised trial of an intervention to improve primary care for refugees in Australia.

ObjectivesTo examine whether primary care outreach facilitation improves the quality of care for general practice patients from refugee backgrounds.DesignPragmatic, cluster randomised controlled trial, with stepped wedge allocation to early or late intervention groups.Setting, participants31 general practices in three metropolitan areas of Sydney and Melbourne with high levels of refugee resettlement, November 2017 ‒ August 2019.InterventionTrained facilitators made three visits to practices over six months, using structured action plans to help practice teams optimise routines of refugee care.Major outcome measureChange in proportion of patients from refugee backgrounds with documented health assessments (Medicare billing). Secondary outcomes were refugee status recording, interpreter use, and clinician‐perceived difficulty in referring patients to appropriate dental, social, settlement, and mental health services.ResultsOur sample comprised 14 633 patients. The intervention was associated with an increase in the proportion of patients with Medicare‐billed health assessments during the preceding six months, from 19.1% (95% CI, 18.6–19.5%) to 27.3% (95% CI, 26.7–27.9%; odds ratio, 1.88; 95% CI, 1.42–2.50). The impact of the intervention was greater in smaller practices, practices with larger proportions of patients from refugee backgrounds, recent training in refugee health care, or higher baseline provision of health assessments for such patients. There was no impact on refugee status recording, interpreter use increased modestly, and reported difficulties in refugee‐specific referrals to social, settlement and dental services were reduced.ConclusionsLow intensity practice facilitation may improve some aspects of primary care for people from refugee backgrounds. Facilitators employed by local health services could support integrated approaches to enhancing the quality of primary care for this vulnerable population.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12618001970235 (retrospective).

Efficacy and safety of carotid endarterectomy in the acute phase of ischemic stroke

Introduction.Nowadays it’s recommended to perform carotid endarterectomy (CEA) in up to 14 days after nondisabling stroke; the procedure is aimed at the prevention of recurrent stroke.The objectiveof this research was the comparison of short-term and long-term (12 months) outcomes with early (in up to 30 days) and delayed (30-180 days) CEA in patients who suffered strokes of various severities.Materials and methods. The research involved 88 patients who underwent CEA in the early stage (Group 1) and 88 patients who underwent CEA in their late period (Group 2). We assessed primary endpoints: ipsilateral stroke, myocardial infarction, 30-day Lethality, 30-day lethality after the surgery, any stroke or infarction (MACE). Secondary endpoints: the same parameters within 12 months after the surgery, post-surgery local or systemic complications, restenosis, changes in neurologic or cognitive status.Results.In 30 days we observed ipsilateral strokes in 3 patients in Group 1 (3.4 percent), it was lethal in 1 patient (1.1 percent). 170 of 176 (96 percent) patients were followed up for 12 months. One lethal stroke was registered in the group of late interventions (1.1 percent). No statistically significant differences were observed between the outcomes in early and late treatment groups. The severity of disability (mRS) in patients of the early intervention group was significantly smaller at discharge and in 12 months after surgery.Conclusion.The advisability of early CEA performance was proven by the absence of differences in post-surgery 30-day and longterm lethality as well as the progress of stroke or infarction with early or late CEA. In 12 months after the surgeries, significant improvement in neurologic status by mRS was only observed in the group of early interventions.

Early Total Versus Gradually Advanced Enteral Nutrition in Stable Very-Low-Birth-Weight Preterm Neonates: A Randomized, Controlled Trial.

To assess whether early total enteral nutrition (80mL/kg/d) started on day 1 of life in hemodynamically stable preterm very-low-birth-weight (VLBW) neonates with the rapid advancement of feeds (20mL/kg/d) help in the earlier achievement of full feeds (180mL/kg/d). Early total enteral nutrition (intervention) group feeding was started with 80mL/kg/d on the first day in all hemodynamically stable neonates admitted with birth weight of 1000-1499grams, born at 29-33 wk of gestation as determined by first-trimester ultrasonography (USG) or expanded New Ballard Score (NBS) and was advanced by 20mL/kg/d until maximum feeds of 180mL/kg/d were achieved; while in control group feeding was started with 30mL/kg/d on the first day and was advanced by 20mL/kg/d until maximum feeds were achieved. Primary outcome measure was time taken to achieve full feeds; secondary outcomes were duration of hospital stay, necrotizing enterocolitis (NEC), time to regain birth weight, duration of antibiotics, and death. Sixty VLBW neonates (1000-1499g) with comparable baseline demographics were randomized within 24h of admission to two groups. Early total enteral nutrition intervention group (group I, n= 31) achieved the target of full enteral nutrition at median 6 d; IQR: 0 to 7.8 d, a significantly shorter time compared to the controls (n= 29) (median 10 d; IQR: 9 to 11.0 d; p= < 0.05). Early total enteral nutrition started from the first day of life results in significantly less time to achieve full feeds in hemodynamically stable preterm and VLBW infants.

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Early surgical intervention enhances recovery of severe pediatric deep neck infection patients

PurposePediatric deep neck space infection (DNI) is a relatively rare but potentially life-threatening condition and requires prompt and accurate management. This study retrospectively reviews our experience in a tertiary referral hospital from 2004 to 2019. MethodsSystematic data collection from medical records using ICD10 codes between 2004 and 2019. Inclusion criteriaage ≤16 years, DNI requiring hospitalization and/or surgery. Exclusionperitonsillar abscess without complications. ResultsWe identified 42 patients, 21 boys and 21 girls, with a median age of 4.9 years. Most of the patients had severe symptoms, the most common of which were neck swelling (n = 39; 92.9%), neck pain (n = 39; 92.9%) and fever (n = 32; 76.2%). Twenty-two (52.4%) had torticollis, and the mean duration of symptoms before hospitalization was 4.95 days. Diagnosis was confirmed by MRI (n = 24), contrast-enhanced CT (n = 11) or ultrasonography (n = 6), except in one case. Twenty-three (54.8%) required an open neck incision, ten (23.8%) patients had intraoral surgery and nine were treated conservatively. Twelve (28.6%) patients were admitted to the pediatric ICU. Median hospitalization duration was six days. The infection most commonly had tonsillopharyngeal etiology (n = 18) and a retropharyngeal location (n = 17). Staphylococcus Aureus (n = 7) and Streptococcus pyogenes (n = 7) were the most frequent pathogens. We compared the early surgical intervention group (<2 days of intravenous antibiotics; n = 18; 42.9%) to the late surgery group (n = 15; 35.7%) and the conservatively treated groups (n = 9; 21.4%). The overall length of stay (LOS) was lower in the shorter preoperative medication group (mean 4.4 vs. 7.2; p = 0.009). The size of the abscess did not differ between the groups (mean 28 mm; 30 mm; 21 mm; p = 0.075) and the neck incision rate was similar in the operated groups. ConclusionEarly surgical intervention is associated with decreased LOS among severe pediatric DNI patients.

Dulaglutide exerts beneficial anti atherosclerotic effects in ApoE knockout mice with diabetes: the earlier, the better

There has been no report about the mechanism for anti-atherosclerotic effects of dulaglutide (Dula) and/or about the difference of its effectiveness between in an early and a late phase of diabetes. To address such questions, streptozotocin (STZ) was intraperitoneally injected to ApoE knockout mice at 8 weeks of age. Either Dula or vehicle was administered to STZ-induced diabetic ApoE knockout mice from 10 to 18 weeks of age as an early intervention group and from 18 to 26 weeks as a late intervention group. Next, non-diabetic ApoE knockout mice without STZ injection were subcutaneously injected with either Dula or vehicle. In an early intervention group, atherosclerotic lesion in aortic arch and Mac-2 and CD68-positive areas in aortic root were significantly smaller in Dula group. In abdominal aorta, expression levels of some villain factors were lower in Dula group. In a late intervention group, there were no immunohistological differences in aortic root and expression levels of various factors between two groups. Furthermore, even in non-diabetic ApoE knockout mice, expression levels of inflammatory and macrophage markers were reduced by treatment with Dula. Taken together, Dula exerts more beneficial anti-atherosclerotic effects in an early phase of diabetes rather than in a late phase.

Parents' Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact.

With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.

Abstract 12899: Early Intervention in Transient ST-Elevation Myocardial Infarction Decreases Mortality: A Meta-Analysis

Introduction: About one-fourth of patient with acute coronary syndrome present with transient ST-elevation myocardial infarction (STEMI). No specific recommendations exist in current guidelines regarding the timing of intervention for such patients due to lack of high-quality randomized trials. Methods: The Cochrane library and PubMed databases were searched for relevant studies. Two authors independently screened and included studies that were randomized controlled trials or observational studies comparing early with delayed invasive strategies in transient STEMI. Efficacy outcomes included target vessel revascularization, reinfarction and recurrent ischemia rates. Primary safety outcome was major bleeding. Random-effects model was used for pooled calculation of odds ratio (OR). Results: Out of all studies found, only 4 studies were included in our analysis (295 patients in early intervention group and 307 patients in delayed intervention group). Delayed intervention was associated with significant increase in all-cause mortality (OR: 2.81 [1.39-5.68], I 2 = 0%, p value = 0.004) (Figure 1). We did not find any significant difference in reinfarction rate (OR: 0.75 [0.12-4.66], I 2 = 0%, p value = 0.75), target vessel revascularization rate (OR: 0.66 [0.11-4.14] I 2 = 0%, p value = 0.66) and recurrent ischemia rate (OR 1.52[0.40-5.84], I 2 = 18 %, p value = 0.54). In addition, major bleeding rate was also similar in both groups (OR 0.68 [0.25-2.25], I 2 = 12%, p value = 0.60). Conclusions: This low to moderate-quality evidence suggests that early invasive strategy might reduce the mortality rate in transient STEMI. There is need of well-designed large randomized studies to gather further evidence regarding the best management of transient STEMI.

Butyrate induced Tregs are capable of migration from the GALT to the pancreas to restore immunological tolerance during type-1 diabetes

Type-1 diabetes (T1D) is an autoimmune disease caused by progressive loss of insulin-producing beta cells in the pancreas. Butyrate is a commensal microbial-derived metabolite, implicated in intestinal homeostasis and immune regulation. Here, we investigated the mechanism of diabetes remission in non-obese diabetic (NOD) mice following butyrate administration. Sodium butyrate (150 mM) was administered to female NOD mice in drinking water after the onset of hyperglycemia (15–25 weeks age) and at 4 weeks of age (early-intervention group). Butyrate administration reduced the progression of hyperglycemia in diabetic mice and delayed onset of diabetes in the early-intervention group with a reduction in insulitis. Butyrate administration increased regulatory T cells (Tregs) in the colon, mesenteric lymph nodes, Peyer’s patches, and its protective effects diminished upon depletion of Tregs. Further, an increase in α4β7, CCR9, and GPR15 expressing Tregs in the pancreatic lymph nodes (PLN) and pancreas in butyrate-treated mice suggested migration of gut-primed Tregs towards the pancreas. Finally, the adoptive transfer experiments demonstrated that induced Tregs from gut-associated lymphoid tissue can migrate towards the pancreas and PLN and delay the onset of diabetes. Our results thus suggest that early administration of butyrate can restore immunological tolerance during T1D via induction of Tregs with migratory capabilities.

Impact of early (&amp;lt;24h) versus delayed (&amp;gt;24h) intervention in patients with non ST segment elevation myocardial infarction (an observational study of 20882 patients)

Abstract Background In patients presenting with non ST-segment elevation acute coronary syndromes (NSTE-ACS) an invasive approach has been shown to be superior to conservative management. Purpose We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention. Methods We examined the impact ofearly (≤24h) versus delayed (&amp;gt;24h) intervention in a large observational cohort of 20882 consecutive patients with acute NSTE myocardial infarction (NSTEMI) treated with PCI between 2005 and 2015 at 9 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching. Results Mean age was 64.5±12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24h.Patients treated within 24h were slightly younger (62.8±12.8 vs. 65.2±12.6, p&amp;lt;0.001), most commonly male (76% vs. 72.9%, p&amp;lt;0.001) and were more frequently ventilated (2.3% vs. 1.4%, p&amp;lt;0.001) and in cardiogenic shock (3.6% vs. 1.4%, p&amp;lt;0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p&amp;lt;0.001). At a median follow up of 4.2 years (interquartile range 1.8 to 7) 17.7% of patients had died. Estimated 5-year survival in patients treated within 24h was 84.6% vs. 81% for those treated &amp;gt;24h following their presentation (p&amp;lt;0.001). This survival benefit remained following adjustment for confounders; HR (delayed vs. early management)1.11 (95% CI 1.003 to 1.23, p=0.046). In the propensity matched cohort of 4356 patients in each group, there remained a trend for higher survival in the early intervention group (p=0.061). Conclusions Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24h) may improve mid term survival. Figure 1 Funding Acknowledgement Type of funding source: None

An EBP to Promote Early Skin-to-Skin Care Intervention and Mother's Own Milk Feedings in the Extremely Low Birth Weight Population.

Describe an evidence-based process (EBP) to promote early skin-to-skin care (SSC) intervention and increase mother's-own-milk (MOM) feedings at discharge among extremely low birth weight (ELBW) infants. This EBP aimed to address the following clinical question: Among ELBW infants, does early SSC &#ξ2264;16 days of life (DOL), compared to SSC >16 DOL, result in more infants receiving MOM feedings at discharge? A retrospective chart review of 199 ELBW infants. Early SSC intervention among ELBW infants and MOM at discharge. Early SSC intervention increased from 46 to 73 percent among ELBW infants over the EBP period. Frequency of SSC intervention was associated with year of EBP and MOM at discharge (p = <.05). ELBW infants in the early SSC intervention group received more MOM at discharge.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial.

The management of early childhood caries (ECC) is challenging. A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.