Months Of Intervention Period Research Articles

DEVELOPING AND RAPIDLY SCALING AN MHEALTH APP IN A 25-SITE PRAGMATIC TRIAL OF ALIVIADO DEMENTIA CARE IN HOSPICE

Abstract Following stakeholder engagement in our pilot phase of a large-scale 2-phase NIA funded pragmatic clinical trial in hospice (HAS-QOL Trial) of Aliviado Dementia Care, we utilized a co-design process to develop over a 6-month period and rapidly scale an mHealth application to assist clinicians in performing best practices in care for persons living with dementia receiving hospice. Throughout the 36 months of intervention period, the app has been utilized by at least 6,580 hospice team members, both to complete training, receive mobile push notification nudges, and: 1) perform 6,682 clinical assessment such as the PAINAD for pain and NPI-Q for behavioral symptoms; 2) develop 2,204 symptom specific care plans; and 3) Review specially developed education materials to 15,128 caregivers and send them to 671 directly. This session will also discuss the process of implementation and scaling, including the technological hurdles in working with a workforce with sometimes limited technical skills.

Impact of Spirulina Chikki Supplementation on Nutritional Status of Children: An Intervention Study in Tumkur District of Karnataka, India

ObjectiveTo assess the impact of Spirulina Chikki supplementation on the nutritional status of children (6 months−6 years).DesignA cross-sectional study design was adopted to assess the changes in nutritional status among the children (after 12 months of intervention period). The bassline and endline assessment were carried out from September 2020 to August 2021, respectively.SettingTotal 106 villages (108 Anganwadi Centers in nine circles) from Tumkur District were covered.MethodsChildren aged 6 months−6 years were the study subjects. Anthropometric measurements viz., height, weight, and mid-arm circumference were collected from total 971 and 838 children during baseline and endline assessments correspondingly. The information on children's health and nutrition status was gathered from the mothers of sampled children. WHO's Anthro and AnthroPlus software were utilized to estimate the anthropometric measurements (Stunting, wasting, and underweight) of study participants.ResultsThe study found apparent disparities in the prevalence of stunting, wasting and underweight among the male and female children. There was a significant decline viz., 4% (28.6%-baseline to 24.5%-end line) in the prevalence of severe wasting. Also, severe stunting dropped by 6% at end line (30%-end-line to 24%-baseline). Improvement in nutritional status was evident among both female male children in all three indicators stunting, wasting, and underweight. Mid-upper arm circumference (MUAC) measurement shows substantial improvements from baseline to end line: SAM (5.3–0.6%), MAM (23–9%), and normal (72–91%). The study discloses significant improvements in the nutritional status among those children who consumed spirulina chikkis/granules for a longer duration viz., 9–10 months as compared to those who consumed for lesser duration.ConclusionsFindings reveal improvement in nutritional status among the beneficiaries who consumed spirulina chikki/granules as per the recommended quantity (amount) during the intervention period. Post intervention, spirulina chikki supplementation for nutritional intervention is implied to address large scale malnutrition among young children.

Enhancing and promoting data management and systematic monitoring for an improved HIV/AIDS programs in Addis Ababa, Ethiopia

BackgroundEthiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB).MethodsAACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50–74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time.ResultsAfter 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23–46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03–77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01–33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38–65.6%] in September 2019.ConclusionsRegular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.

SUN-240 EFFECT OF EXERCISE TRAINING ON CARDIOVASCULAR AND KIDNEY OUTCOMES IN CHRONIC KIDNEY DISEASE PATIENTS: AN OVERVIEW OF SYSTEMATIC REVIEWS

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Studies suggest inadequate physical activity is related to impaired cardiovascular reserve capacity and higher mortality in CKD patients. Clinical trials and systematic reviews about the effect of physical activity and exercise programs in CKD patients are increasing, but not systematically evaluated. Here, we conducted an overview of systematic reviews to assess the effects of regular exercise on cardiovascular and kidney outcomes in non–dialysis CKD populations. Systematic reviews of randomized controlled trials (RCTs) that evaluated the effects of exercise on cardiovascular and kidney outcomes in non–dialysis CKD patients were included. Searching was conducted in the databases of CENTRAL, Embase, PubMed, and Web of Science up to October 2018. We assessed the quality of included reviews by using the revised “A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2)” instrument. The quality of evidence for the reported outcomes was evaluated by the “Grading of Recommendations Assessment, Development and Evaluation (GRADE)” framework. Five reviews with 123 RCTs and 4,598 participants were included. Of these, 34 RCTs (1,111 participants) examined exercise versus standard care in adults with non–dialysis CKD. The most common exercise was aerobic training, followed by mixed and resistance training. Most studies scheduled exercise 3 times per week with moderate intensity, lasting 20 to 60 minutes per session, with 2 to 18 months of intervention period. Based on AMSTAR 2 instrument, the overall report quality of included reviews was low. Reporting of protocols and sources of funding of the included studies was lacking, with only one review met all required items in AMSTAR 2 instrument. The quality of the evidence for the cardiovascular and kidney outcomes was low to moderate due to the high heterogeneity and potential publication bias. The diverse exercises programs tested in included studies could be the cause of inconsistency. Compared to standard care, regular exercise showed benefits in aerobic capacity (peak oxygen uptake, 11 RCTs, 325 participants, MD 2.39 ml/kg per min, 95%CI 0.99 to 3.79, low evidence) and kidney function (glomerular filtration rate, 10 RCTs, 305 participants, MD 2.16 ml/kg per 1.73 m2, 95%CI 0.18 to 4.13, moderate evidence). The outcomes of blood pressure and arterial stiffness had insufficient evidence. None of systematic reviews reported outcomes regarding to CVD events and mortality. Regular exercise improves aerobic capacity and retards kidney progression. The efficacy of different types of exercise training on CVD events in patients with CKD has yet to be confirmed in the future randomized control trials with adequate follow-up period.

Antibiotic Prescribing Trends Before and After Implementation of an Audit and Feedback Program in Internal Ward of a Tertiary Hospital in Tehran.

We implemented a post prescribing review and feedback program to investigate its effect on appropriateness of antimicrobial use and antimicrobial consumption rate. A pre-post interventional study conducted in internal ward of Imam Hossein teaching hospital. For nine months of intervention phase, medical file of all patients who received intravenous antibiotic were reviewed by a clinical pharmacy specialist. Discrepancies from international and local guidelines were discussed with physicians. Outcome measures included appropriateness of antimicrobial usage, length of stay, and broad-spectrum antimicrobial usage rate. A total of 198 antibiotic courses (154 in intervention phase and 44 in pre-intervention phase) were reviewed. One-hundred sixty-seven recommendations in treatment course of 75.3% of patients were made. The most common recommendations were discontinuing antibiotics and changing from intravenous to oral therapy (35% and 22%). The acceptance rate was 80.2%. Rate of discrepancies from guidelines was compared between pre-intervention and two last months of intervention period which showed a significant reduction in antibiotic choosing (47%, P-value < 0.001), de-escalation (48%, P-value < 0.001), on time changing intravenous to oral therapy (60%, P-value < 0.001) and dosing schedule (30%, P-value = 0.003). Hospital length of stay showed a significant reduction from 16.1 days to 11.6 days (P-value < 0.05) between pre-intervention and post-intervention group. Mortality rate was not different in the patients that intervention in their treatment was accepted vs. rejected (P-value = 1.00). There was a reduction trend in consumption rate of Carbapenems, Vancomycin, and Ciprofloxacin. Therefore, prospective audit and feedback program effectively decreased inappropriate treatment and hospital length of stay with no effect on mortality.

Variasi Kolesterol Plasma Individual Monyet Ekor Panjang (Macaca fascicularis) sebagai Respons terhadap Diet Aterogenik IPB-1 (INDIVIDUAL PLASMA CHOLESTEROL VARIATION OF CYNOMOLGUS MACAQUE (MACACA FASCICULARIS) IN RESPONSE TO IPB-1 ATHEROGENIC DIET)

The effectiveness of atherogenic diet in raising plasma cholesterol level of cynomolgus macaques(Macaca fascicularis) can be predicted for population, but not for individuals.This study aimed to evaluatethe individual plasma cholesterol of cynomolgus macaques in response to IPB-1 atherogenic diet. Theanimals under study were 22 adult malemonkeys from the animal facility of Primate Research CenterBogor Agricultural University (PSSP IPB). All animals were intervened with the IPB-1 atherogenic diet forthree months and individual plasma cholesterol wasevaluated in a monthly basis.The results showedthat the monkeys’ plasma cholesterol had increased significantly (P <0.05) after one month of interventionperiod and the increases were very significantly different (P <0.01) after three months. Individually, increasesin plasma cholesterol varied among animals. Based on these variations, 2 animals were categorised ashypo-response, 18 animals as hyper-response and 2 animals as extreme.This study showed the variationof individual plasma cholesterol of cynomolgus macaques in response tothe IPB-1 atherogenic diet so thatthe animals might be selected based on the their responsiveness.

Impact of an Antimicrobial Stewardship Program on Unnecessary Double Anaerobic Coverage Prescription.

BackgroundCo-administration of two or more antimicrobials with anti-anaerobic activity is not recommended except in certain circumstances. We therefore conducted an intervention to reduce unnecessary double anaerobic coverage (DAC) prescription.Materials and MethodsThe intervention consisted of education using an institutional intranet and prospective audits and feedback provided through collaboration between a pharmacist and an infectious diseases physician in Seoul National University Bundang Hospital, a tertiary hospital in Seongnam, Republic of Korea, in 2013. The study period was 1 year which contained 6 months of pre-intervention period and 6 months of intervention period. To estimate the overall effect of the intervention, we compared the monthly number of patients receiving unnecessary DAC for more than 3 days and the proportion of patients receiving unnecessary DAC for more than 3 days among all patients receiving DAC.ResultsThe average monthly number of patients receiving unnecessary DAC for more than 3 days after screening decreased by 73.9% in the intervention period from 26.8 to 7.0. Wilcoxon rank sum test revealed there was a significant statistical difference in the monthly number of patients receiving unnecessary DAC for more than 3 days (P = 0.005). The proportion of patients receiving unnecessary DAC for more than 3 days after screening among all patients identified as receiving necessary or unnecessary DAC also decreased by 67.8% in the intervention period from 42.3% to 13.6% (P < 0.001).ConclusionThe multidisciplinary antimicrobial stewardship program with combined methods reduced unnecessary DAC prescription successfully.

Language Outcomes Using Hearing Aids in Children with Auditory Dys-Synchrony.

There is a considerable debate on the use of hearing aid in children with auditory dys-synchrony (AD). To current date there are no similar Studies which show the effect of acoustic amplification on outcomes on speech and language development in children with AD are found in the literature. Thus, in the present study three children diagnosed to have AD were recruited and subjected to hearing aid trial and fitting based on the late latency response thresholds. Ranging from 7 months to 41 months of intervention period, each child’s language age was reassessed and compared with that of their pre-therapy language age. The comparison showed a good improvement in receptive age, though the children had moderate to severe degree of hearing loss. But their expressive age was significantly delayed irrespective of their age of identification and duration of intervention. Thus the delay in expression with a good amount of improvement in reception can be a characteristic of an AD child with amplification.

Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report

Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC's National Healthcare Safety Network (NHSN). Quality improvement project. Patients in 17 outpatient hemodialysis facilities that volunteered to participate. Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff. Crude and modeled BSI and access-related BSI rates. Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods. Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P = 0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period. Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project. Facilities participating in a collaborative successfully decreased their BSI and access-related BSI rates. The decreased rates appeared to be maintained in the intervention period. These findings suggest that improved implementation of recommended practices can reduce BSIs in hemodialysis centers.

P3-08-01: Effects of an Integrated Yoga Program on Mood States, Distress, Quality of Life, Diurnal Cortisol Rhythms and Natural Killer Cell Counts in Metastatic Breast Cancer Survivors.

Abstract Background and objectives: Metastatic breast cancer patients experience tremendous psychological distress due to treatment, disease and uncertainty of their survival. In this study we evaluated the effects of an integrated yoga program versus supportive counseling in advanced breast cancer survivors. Methods: Ninety one Metastatic breast cancer survivors (group mean age 50.54 yrs ± 8.53 yrs) registered in hospital based cancer registry were recruited if they satisfied selection criteria and gave written consent for participation in the study. The study was approved by the institutional review board. Subjects were randomized to either receive yoga intervention (n=45) or supportive therapy (n=46) counseling as a standard of care for 3 months of intervention period. Subjects were assessed at baseline and after intervention for mood states using hospital anxiety and depression scale, sleep quality using Pittsburg Insomnia rating scale, quality of life using EORTC Qol C30 for breast and perceived stress using perceived stress scale. Saliva samples were collected for three consecutive days at 0600hrs, 0900hrs and 2100hrs before and after intervention for cortisol rhythms using Enzyme Immune Assay kits from Salimetrics and blood samples were collected between 0800hrs to 01000hrs for NK cell enumeration using flow cytometry. 35 subjects in yoga and 31 subjects in controls completed the post measures. Data were analyzed using both parametric (ANCOVA with respective baseline measure as a covariate) and non parametric tests (Mann whitney U test) to evaluate effects of intervention on the above outcome measures. Data for salivary cortisol data was log transformed, area under the curve and cortisol slope computed using linear mixed effects model. Results: There was a significant decrease in anxiety (p &amp;lt; 0.001), depression (p &amp;lt; 0.001), perceived stress (p = 0.01), fatigue severity (p &amp;lt; 0.001) and interference (p &amp;lt; 0.001) in yoga group compared to controls post intervention. There was a significant improvement in emotional function (p &amp;lt; 0.001), role function (p = 0.03) and cognitive function (p &amp;lt; 0.001) and global quality of life (p &amp;lt; 0.001) in yoga group compared to controls. There was significant decrease in 0600 hrs cortisol within the yoga group (p =0.03) alone. There was a significant increase in Natural killer cell percent in yoga group (p =0.03) compared to controls after intervention. Conclusion: The results suggest biobehavioral effects of yoga intervention could possibly improve quality of life, reduce psychological distress and modulate abnormal cortisol profiles and immune responses in metastatic breast cancer patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-08-01.

Effect of learning attachment behaviors on anxiety and maternal fetal attachment in first pregnant women

Background: Anxiety with different shapes induces some complications in women in their first pregnancy. Reducing anxiety level can promote maternal-fetal health. Aim: to examine the effect of learning the “attachment behaviors” on the anxiety level and “maternal fetal attachment” in first pregnant women referring to Shiraz obstetric clinics in 2010 Methods: In this randomized control trial 84 pregnant women were allocated in two groups randomly. Experimental group received routine pregnancy care in addition to four 90- minutes’ sessions on the attachment behaviors during one month of intervention period. The control group received usual pregnancy services. Anxiety and maternal fetal attachment were measured before and after intervention in two groups. Data were collected using Spielberger's State Anxiety Inventory and maternal fetal attachment scale Cranley. Data were analyzed with SPSS software (v.11.5), using statistical tests including Chi square, pair T test, and T test. P value less than 0.05 considered statistically significant. Results: women in the case group experienced significantly less anxiety and more maternal fetal attachment after learning attachment behaviors (p=0.003, p <0.001). No significant changes were found in the control group. Conclusion: educating the attachment behaviors can increase maternal fetal attachment and reduce women’s anxiety in their first pregnancy. It could be suggested to include teaching this subject in to pregnancy health care services.

STRATEGI BARU PENYULUHAN GIZI-KESEHATAN DALAM MENINGKATKAN PERILAKU SEHAT IBU SELAMA HAMIL DAN MENYUSUI

A New Strategy of Nutrition Education In Improving Health Behaviour of Pregnant and Lactating Women. Background: The new health paradigm of the year 2010 is emphasizing on preventive and promotive measures through the improvement of health behavior of the population. On the same time, the economic crisis has worsened the nutritional status, particularly for pregnant and lactating women, leading to increase of malnutrition and mortality among infants and women. Programs in improving health behavior, particularly in many nutrition programs, have poorly designed and poorly implemented at grass root levels and therefore may not assess nutrition knowledge, attitude and practice prroperty, with the consequence that the results may have little meanings. Objective: The aim of the study was to examine model of empowering pregnant and lactating women through, the improvement of heatlh and nutriton behavior by using the method of Women's Contact. Women's Contact or Kontak Ibu was a trained person who always give services to pregnant and lactating women, including midwives, traditional birth attendants, community volunteers, such as ceders, etc. Methods: The study areas were located in Bogor and Tangerang Districts. In the treatment group areas 21 Kontak Ibu were trained for 2 days in improving their skills in nutrition and heatlh education and supervised. In the control group areas 20 Kontak Ibu were trained for 1 day and Without supervised during the 4 months of intervention period. The material of nutrition and heatlh education developed by the previous study, was provided for all Kontak Ibu. In the treatment area 80 women (40 pregnant and 40 lactating) received the services given by Kontak Ibu. The same number and proportion of women also received the services in control areas. Results: The performance of Kontak Ibu in the treatment areas generally better than in the control areas in term of the frequency of giving education, number of women receiving services, referral forms completed, and number of targeted women visited. The women who improved their practices in solving the problem of morning sickness and low appetite for pregnant women, and problem of eating and diarrhea for infants were significantly (p<0.05) higher in the treatment than in the control group. Other practices, such as solving problem of headache, edema, vances. fever, etc. were improved in both groups. Conclusion: It is found in both group the new service strategy using method of Kontak Ibu changed several behaviors among women in communites. The changes in the experiment group were more remarkable than in the control group. Suggestion: The strategies of Kontak Ibu services changed behavior of both the service providers ard the women seeking services. It is therefore likely that application of the model Kontak Ibu services could be implemented in the existing nutrition improvement programs. Key words: nutrition education, behavior, pregnant and lactating women, women's contract