Non-intervention Group Research Articles

A Quality Improvement Initiative to Increase the Frequency of Vaginal Delivery in Brazilian Hospitals.

To evaluate a quality improvement (QI) initiative designed to increase the frequency of vaginal delivery in Brazilian hospitals. Twenty-eight hospitals enrolled in a 20-month (May 2015-December 2016) Breakthrough Series Collaborative that used QI methods to increase implementation of obstetric approaches with potential to increase the frequency of vaginal delivery. All hospitals contributed qualitative data for iterative redesign. Thirteen intervention hospitals with complete data contributed to an analysis of changes in vaginal delivery in a targeted population over time. Hospitals from the São Paulo region (five intervention and eight nonintervention) contributed to a comparator analysis of changes in vaginal delivery for all deliveries over time. Most hospitals targeted low-risk pregnancies in primiparous women, delivered by hospital-employed obstetricians or admitted through emergency departments, and some included all pregnant women. The collaborative tested four interventions to increase vaginal delivery: 1) coalition building of stakeholders with the common purpose of ensuring "appropriate delivery," 2) empowering pregnant women to choose their preferred mode of delivery, 3) implementation of new care models favoring physiologic birth, and 4) improved information systems for continuous learning by health care providers. For 119,378 targeted deliveries (36% of all deliveries) in 13 intervention hospitals, vaginal delivery increased from 21.5% in 2014 to 34.8% in 2016, a relative increase of 1.62 (95% CI 1.27-2.07, P<.001). In the comparator analysis, vaginal delivery for all deliveries in the five São Paulo intervention hospitals increased from 16.1% to 23% (RI 1.43, P<.001) and from 11.0% to 13.0% (relative rate ratio 1.18, P<.001) in the eight nonintervention São Paulo hospitals. The relative increase in vaginal delivery between the São Paulo intervention and nonintervention groups was 1.21 (95% CI 1.05-1.41, P=.01). The rate of maternal adverse events and neonatal intensive care unit admissions for newborns who weighed at least 2,500 g did not differ significantly during the observation period. Key interventions implemented with QI methods were associated with increased vaginal delivery. This approach may help address the global cesarean delivery epidemic.

Parental knowledge and attitudes regarding asthma in their children: Impact of an educational intervention in an Indian population

Research shows positive effects of asthma education in improving parental knowledge, self-management skills, and reducing healthcare costs. Such studies are lacking in resource-limited countries. We studied the effectiveness of educational intervention in improving the knowledge and attitudes of parents/caregivers of asthmatic children. The study was conducted in the pediatric chest clinic of tertiary hospital (India) over 21 months after ethics committee approval. Recruited parents were randomized into the interventional group (A) receiving education module and control group (B). Parents' asthma knowledge and attitudes were assessed at baseline and 5 months postenrollment using 25-item questionnaire. Detailed demographic data, clinical data, and exacerbations during study were noted. A total of 75 parents/guardians fulfilling inclusion criteria were analyzed (cases/group A: 37 and controls/group B: 38). 8.3 percent of parents/caregivers were illiterate. Around 36.9% of patients had a family history of allergy/asthma. Mean knowledge scores at follow-up were 12.24 and 9.89 for groups A and B, respectively (P < .05). Parents did better on knowledge items related to chronicity, family history, chronic cough, home administration of steroids in acute severe asthma, and maintaining records of clinical/medications for good control. Intervention group (A) showed significant improvement in most attitude-based questions postintervention as compared with the nonintervention group (B). There was no statistically significant difference in asthma severity and control between the two groups at follow-up. Small group education on asthma in parents/caregivers improves their knowledge and attitudes. Healthcare plans should invest in pediatric asthma education and identify key personnel/opportunities to impart the same in routine care.

Rational Emotive Occupational Health Coaching in the Management of Police Subjective Well-Being and Work Ability: a Case of Repeated Measures

Low subjective well-being and work ability constitute threats to employees’ job performances across the world. Indices of low subjective well-being have been observed among police officers in Nigeria and have been linked to their occupational experiences. Managing enhanced subjective well-being is paramount for police officers’ job effectiveness. The current study investigated the effectiveness of rational emotive occupational health coaching (REOHC) in enhancing subjective well-being of police officers in Enugu state, Nigeria. Participants (N = 151) included police officers with not less than 5-year working experience who were randomly assigned to intervention (N = 76) and nonintervention (N = 75) groups. Participants in the intervention group were exposed to 120-min REOHC program weekly for a period of 16 weeks. Subjective well-being scale (SWBS) and perceived work ability index (PWAI) were used to collect data at pre-test, post-test, and follow-up assessments. Data collected were analyzed using independent samples as well as paired sample t test statistics and repeated measure ANOVA. Results revealed that participants in the intervention group had significant improvement in their life satisfaction, affect balance, and flourishing scores at post-test and follow-up assessments compared with the pre-test. Participants in the nonintervention control group did not have a significant change in subjective well-being subscale scores across pre-test, post-test, and follow-up evaluations. The conclusion drawn was that REOHC can be effective in managing subjective well-being among police officers and employees who work under chronic stressful conditions.

Effect of Health Education on Knowledge Attitude Practice towards Malaria among Basic Schools Pupils in Taiz

Background: Malaria is one of the main health problems in Yemen. Health education is essential for the control of diseases such as malaria. School-age children represent 25% of Yemen’s population. Schools children can convey the knowledge and skills that they acquire at school to the community, thus increasing general community awareness about malaria. Aim to determine the impact of school-based malaria education intervention on knowledge, attitude and practice of school children towards malaria prevention and control. Methods: We conducted a community-based trial, intervention and non-intervention comparison (exposed & non-exposed), in four randomly selected districts (rural and urban) of Taiz governorate. This study was conducted in four districts of Taiz governorate. The study population was 2130 pupils of grade 6, 7, and 8 in primary schools, chosen from four randomly selected districts; two of them were rural and the others urban. Four schools and their pupils (1065 pupils) were chosen for the study and assigned as an intervention group and four schools with their pupils (1065) were chosen for the study and assigned as a non-intervention (1065 pupils). Data were collected using questioner in intervention and non-intervention schools (three months apart). The major intervention activities included lectures about malaria, distribution of educational materials. χ2 was used to analyze differences. Results: Health education activities in schools were associated with the increased knowledge of malaria symptoms and methods of prevention. The mean knowledge of malaria symptoms is higher in the intervention schools 4.4 ± 1.9, compared with 2.1 ± 1.4 in the non-intervention group. With statistically significant difference (P < 0.001), also the positive attitude and practice toward malaria was higher to be (48%) in the intervention group; compared with (35%) in the non-intervention group the difference was statistically significant. The knowledge of mode of malaria transmission was higher in the intervention schools to be (86.2%) compared with (59.1%) in the non-intervention group, with statistically significant deference (P value <0.001). The knowledge of fever as a main malaria symptom was higher to be (90.4%) in the intervention schools compared with (63.6%) in the non-intervention schools with statistically significant deference. Conclusions and Recommendation: This study concludes that the health education intervention in primary schools in Taize governorate had a positive impact on the knowledge, attitude and practice of pupils. We recommend to conduct similar methods of the health education activities in schools with suitable modifications to reach all schools level.

Anxiety and depression related to yog nidra among professional students

Background: Anxiety is one's response to stress. Its symptoms can be psychological, physical, or environmental challenges. Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feeling of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Yog nidra is probably the best known technique to induce complete physical and emotional relaxation. Aim: The aim of this study was to explore the effectiveness of yog nidra for reducing anxiety and depression among first-year professional students. Materials and Methods: The level of anxiety was measured by using State, Trait, and Free-Floating Anxiety Scale developed by Tripathi and Rastogi (1986). The Hindi version of Beck Depression Inventory by Arora and Prashant (1988) was used to assess the depression level of participants. The study was conducted in three phases. In Phase-1 (preintervention), data were obtained from 201 students. In the Phase-2 (intervention phase), the participants were selected on the basis of high scores on the measures of anxiety and depression and divided into intervention (28 students) and non-intervention groups (30 students). The intervention group was given yog nidra training regularly for 5 weeks. Posttest was conducted after 5 weeks of the intervention. Results: The results showed a reduction in mean scores on the measures of anxiety and depression within the intervention group but not in the nonintervention group, which indicated the effectiveness of practicing yog nidra for reducing anxiety and depression and its positive effects among professional students. Conclusion: A dramatic effect of practicing yog nidra was observed among students for reducing anxiety and depression.

Impact of Applying Palliative Care on Symptoms and Survival of Patients with Advanced Chronic Disease Admitted to the Emergency Department.

Introduction:In the emergency department, there is a need to provide palliative care; however, they are not usually administered. The present study evaluates the evolution of the intensity of the symptoms when applying palliative care, in adult patients with advanced chronic disease admitted to the emergency room, and compares survival between those who receive this care and those who do not.Materials and Methods:A clinical intervention study was conducted including patients older than 18 years with advanced chronic disease admitted to the emergency room with an indication of palliative support according to the Supportive and Palliative Care Indicators Tool 2015. Three hundred and seven patients were studied (74 in the intervention group and 233 in the group not intervened). In the intervention group, the intensity of pre- and postintervention symptoms was compared (Wilcoxon test). The survival of both the groups were then compared (logrank test).Results:There was a significant decrease in pain and dyspnea at 24 and 48 h postintervention (P < 0.01), respectively, while drowsiness increased significantly at 24 h (P < 0.01) but did not change at 48 h (P = 0.38). Excluding patients with better functional status, there was less survival at 3 months in the intervention group (P = 0.01).Conclusions:Dyspnea and pain decreased with the application of palliative care but not drowsiness. Survival in the intervention group was lower than in the nonintervention group. However, the reason for providing palliative care is to relieve suffering at the end of life.

Comparison of sputum conversion time in tuberculosis treatment with fix-dose combination drugs and separate drug regimens

During tuberculosis (TB) treatment, the period of transmission will shorten and disease will be better controlled in the society if the drugs be more potent and the sputum conversion time from positive to negative be less. There are two drug regimens in the treatment of TB: fixed-dose combination drugs and separate-dose drugs. Our aim in the study was comparing the sputum conversion time pattern in TB smear-positive patients treated with the aforementioned regimens. This randomized clinical trial was done on 331 patients with smear-positive TB. Randomization was based on random numbers table. Intervention group was treated with fixed-dose combination, and nonintervention group was treated with separate drugs. Smear conversion time pattern at the end of second, third, fourth, and sixth months after beginning of the treatment was compared and analyzed by extended Cox regression test. Sputum smear conversion rate in the intervention and control group at the end of second, third, and fourth months of treatment was 70.23 versus 76.47%, 54 versus 67.24%, and 33.33 versus 68.75%, respectively (P>0.05). Variables such as smoking, drug addiction, and sputum bacillary load were effective on smear conversion time in two study groups. The study results showed no difference in efficacy of two-drug regimens in conversion time of sputum smears to negative in TB smear-positive patients.

Role of Platelet-rich Plasma in the Healing of Impacted Third Molar Socket: A Comparative Study on Central India Population

The aim of the study was to compare the healing and osseous regeneration of mandibular third molar extraction sockets with and without platelet-rich plasma (PRP) with the evaluation of clinical objectives such as pain, swelling, trismus, soft tissue healing, pocket depth distal to second molar and radiological evaluation of the bony density in the postextracted third molar socket. In this prospective study, 100 patients were selected by the random sampling method from the outpatient department of oral and maxillofacial surgery in the year 2016-2017. Patients were equally allocated into intervention (transalveolar extraction followed by PRP placement) and nonintervention (transalveolar extraction without PRP placement) group as group I and group II, respectively, and evaluation parameters were considered accordingly. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 (IBM, USA) statistical analysis software. The pain score of patients of group I (non-PRP) was found to be higher as compared to group II (with PRP). Mean trismus of patients of group II was found to be higher than that of group I at postoperative day 7, but this difference was not found to be statistically significant. Swelling at T-Sn (Tragus-Subnasale) and T-Pog (Tragus-Pogonion) was higher among patients of group I as compared to group II. Healing in group II was two to three times faster than group I. Healing among patients of group I and group II was found to be statistically significant. The mean pocket depth of patients of group I was found to be significantly higher than that of group II at follow-up of 1 and 2 months. The bone density of patients of group II was found to be significantly higher than that of group I at 3 months and 6 months follow-up. The procedure of PRP preparation is simple and cost-effective, and can be prepared at the point of care. It had a significant impact on the postoperative healing of the third molar socket. The use of PRP application increases the bone density, healing process, and improvement in the pain and swelling, and there was a definite reduction in trismus and periodontal probing depth after the impacted mandibular wisdom teeth extraction.

Mulabandha yoga therapy and its utility in cases of urinary incontinence in females: A randomized clinical trial

Background: Urinary incontinence (UI) is a common condition in women, with prevalence ranging from 8.5% to 38% depending on age, parity, and definition. This problem is more common in Asian countries, where women usually do not seek treatment for their reproductive health problems and do not vocalize their symptoms. Mulabandha yoga therapy (MYT) is said to be effective for the management of UI. Hence, it was tried to see the effects of this method in females. Aims and Objective: The aim and objective was to study the effect of yoga therapy in female patients for 3 months suffering from UI. Methods: An intervention of Mulabandha yoga therapy (Contraction of pelvic group muscles) for the period of three months has been done by interventional group. Design: Participants were allocated into two groups by generating random allocation sequence. Participants: Fifty female participants were divided into two groups, i.e., interventional and noninterventional (control) groups. The interventional group (n = 25) received an intensive supervised MYT protocol along with medication and the control group (n = 25) received only oral medicines. Outcome Measures: Improvement in UI symptoms was assessed using the Questionnaire for Urinary Incontinence Diagnosis (QUID). Both groups were evaluated at the beginning of the study and after 12 weeks. Results: At the completion of study, data received from all the fifty women were included in the analysis. Percentage improvement in the QUID mean change was 58.72 in the intervention group and 21.54 in the control group. Intergroup comparison (Mann–Whitney test) was found to be statistically significant in the intervention group (p &lt; 0.00), whereas it was nonsignificant in the control group (p = 0.14). Conclusion: MYT plays a significant role in the improvement of UI symptoms.

함수적 사고를 강조한 ‘규칙과 대응’ 수업에 참여한 초등학생들의 이해 분석

Recently, there has been an active effort to reflect on the perspective of functional thinking in an elementary mathematics curriculum and to explore its effects. Given this, the purpose of this study was to compare students’ understanding of the unit of “Patterns and Correspondence” between two groups: the intervention group who learned it with new materials emphasizing functional thinking and the non-intervention group who learned it with the textbook. For this purpose, the students from three classes participated in this study and they completed pre-post test. The results of this study showed that in the post-test the intervention group performed better than the non-intervention group in exploring for a correspondence relationship using a non-sequential T-table, representing it by an expression with variables, and finding out real-life contexts appropriate to the given expression of a correspondence relationship. This paper closes with some implications on how to teach functional thinking in elementary mathematics.

Effect of vitamin D intervention on the outcome of glucose metabolism in patients with impaired glucose regulation

Objective To explore the intervention effect of low-dose vitamin D on glucose metabolism of patients with impaired glucose regulation. Methods A total of 196 subjects receiving oral glucose tolerance test were enrolled in this study, including individuals with normal glucose tolerance (NGT group, n=67) and individuals with impaired glucose regulation (IGR group, n=129). The IGR group was divided into intervention group (n=64)and non-intervention group (n=65) according to vitamin D intervention (for 1 year) performed or not. Clinical data and biochemical parameters were collected. Results The level of serum 25(OH)D3 was significantly lower in the IGR group than that of normal control group (P<0.05). After 1 year of low-dose vitamin D intervention, insulin sensitivity increased and insulin resistance decreased in the intervention group as compared with non-intervention group. Diabetes developed less frequently in the intervention group (25 of 64 [39.1%]) compared with non-intervention group (30 of 65 [46.2%]). But there was no significant different in diabetes prevalence between the two groups. Conclusions Vitamin D intervention can improve insulin sensitivity and reduce insulin resistance in patients with impaired glucose regulation. Low dose vitamin D can improve the abnormal glucose metabolism outcome in patients with impaired glucose regulation. Key words: vitamin D; 25(OH)D3; type 2 diabetes mellitus; insulin secretion

Effects of Cytotoxic T Lymphocyte-Associated Antigen 4 Immunoglobulin Combined with Microbubble-Mediated Irradiation on Hemodynamics of the Renal Artery in Rats with Diabetic Nephropathy

Cytotoxic T lymphocyte-associated antigen 4 immunoglobulin (CTLA-4-Ig) can inhibit the effect of B7-1 and improve renal hemodynamics in rats with diabetic nephropathy (DN). Nevertheless, a strategy that could increase the permeation of CTLA-4-Ig through endothelial cells and basement membrane remains to be discovered. We investigated the effect of CTLA-4-Ig combined with microbubble-mediated irradiation on the hemodynamics of renal arteries in DN rats. Rats were treated with CTLA-4-Ig and/or microbubble exposure. After 8 wk of intervention, color Doppler ultrasonography was used to detect peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), systolic acceleration (SAC), pulsatility index (PI) and resistance index (RI) of the renal artery trunk. The CTLA-4-Ig + microbubble exposure group exhibited significantly higher PSV, EDV and MV than the CTLA-4-Ig group, which had significantly higher values than the non-intervention group. The CTLA-4-Ig + microbubble exposure group exhibited significantly lower SAC, PI and RI than the CTLA-4-Ig group, which had significantly lower values than the non-intervention group. Our results indicate that both CTLA-4-Ig and CTLA-4-Ig + microbubble exposure can reduce the blood flow resistance and improve the blood flow velocity of renal arteries in rats. Moreover, the effect of CTLA-4-Ig + microbubble exposure is better than that of CTLA-4-Ig alone. Our study provides a new, effective and non-invasive strategy for the treatment of DN.

Can Mobile Technology Improve Weight Loss in Overweight Adults? A Systematic Review.

The purpose of this systematic review was to identify evidence concerning the effectiveness of mobile applications and wearable devices for weight loss in overweight adults. A database search of PubMed and CINAHL yielded 12 eligible articles following the application of inclusion and exclusion criteria. Inclusion criteria consisted of studies primarily pertaining to obesity, inclusion of adult population only (18 years and older), use of experimental study designs only, use of mobile apps or wearable devices as intervention(s), and primary outcome of weight loss. Overall, the research evidence suggests that mobile apps and wearables are effective self-regulating tools for weight loss. Although study design concerns, such as lack of non-intervention comparator groups, prevent a definitive conclusion regarding the relative power of mobile apps and wearables over other self-monitoring methods, evidence indicates that mobile technology can be used as integral tools within overarching weight loss strategies recommended in the primary care setting.

Educating health professionals for cultural competence in emergency situations: A study protocol for a randomized controlled trial.

The current study is aimed at developing a culturally informed education program to increase cultural competence in emergencies among healthcare students and to examine its effectiveness using a randomized controlled trial. This is a mixed-methods study, which comprises two phases: (a) Development of educational intervention to increase cultural competence, based on a review of published scientific literature and primary data collection from qualitative semi-structured interviews with key informants; (b) Implementation and assessment of the intervention effectiveness in increasing cultural competence in health students, using a randomized controlled trial. The qualitative phase will include semi-structured interviews with 10 key informants. Data will be analysed using Interpretative Phenomenological Analysis. The assessment of intervention efficacy will be examined by a randomized controlled trial. This phase will include a total of 200 undergraduate health profession students who will be randomized (1:1 ratio) to intervention or non-intervention group. Both study groups will complete pre- and postintervention questionnaires assessing three principles of cultural competence: attitudes, knowledge, and skills. The study is supported by 2-year funding, beginning in September 2018. Although the importance of culturally sensitive health services has long been recognized, there is a lack of cultural competence training in the medical education system, especially in the context of emergencies. Incorporating cultural competence education into the curricula offers an appealing strategy to enhance systematic understanding of cultural diversity at the early stages of professional training. The development of cultural competence training and curricula focusing on situations that may arise during emergencies may play a significant role in minimizing cultural dissonance, improve patient-provider communication, and produce better clinical outcomes.

Compliance with sedation analgesia protocols: Do clinical pharmacists have an impact?

The agreement between prescribed sedation objectives and sedation pump syringe rate adaptation is not optimal. Delays in adjustment of sedation doses are associated with an increased patient length of stay in the intensive care unit. Our objectives were to assess compliance with the approved sedation protocol and to evaluate the impact of a clinical pharmacist daily controlling sedation and analgesia scores and pump syringe rates on patients' outcomes in a critical care unit. Prospective before/after study involving 60 adult patients divided into two groups (non-intervention and intervention groups) who received mechanical ventilation and continuous infusions of sedative and analgesic drugs in an intensive care unit. In both groups, data were collected daily in 30 mechanically ventilated patients receiving a sedation/analgesia regimen during a 3-month period according to a standardized protocol. A pharmacist was in charge of intervening with physicians when the local sedation analgesia protocol was not followed. There were no significant differences between the groups in terms of demographic characteristics except a higher proportion of men in the intervention group (70% vs 40%, P=.019). In the control group, sedation and analgesia objectives were not prescribed in more than half the cases. Pharmacist intervention reduced sedation duration (5 [2-11] vs 2 [1-5.5]days, P=.019). The cumulative delay in adaptation of the sedation analgesia electric syringe pump was significantly decreased in the intervention group (8 [0-29.5] vs 28.5hours [11.1-68.4], P=.034). Total doses of sedatives (midazolam, propofol) and analgesics (sufentanil, remifentanil) per patient were decreased in the intervention group compared to the control group (respectively, P=.24, P=.0009, P=.0013 and P=.0007). Pharmacist intervention can decrease the sedation duration and the total dose of sedation medications and reinforce adherence to sedation/analgesia guidelines.

Effects of facial rehabilitation exercise on the mood, facial expressions, and facial muscle activities in patients with Parkinson's disease

Facial expressions are often impaired in patients with Parkinson's disease (PD). Few studies have examined the effects of head and neck rehabilitation in patients with PD using a facial expression analysis. In the present study, to further elucidate the effects of facial rehabilitation exercise in patients with PD, a three-dimensional facial expression analysis with FaceReader™ and surface electromyography (EMG) were performed in order to assess the facial expressions and muscle activities, respectively. The effects of such exercises on the mood and mental health were also evaluated. Twenty-one patients with PD (63.3±12.1 years) participated in the present study and were randomly assigned to an intervention group and non-intervention group. Facial rehabilitation exercise was performed for 60 minutes once a week for 12 weeks in the intervention group. GHQ-12, the facial expression analysis with FaceReader™, surface EMG, and the VAS scale for mood changes were used to evaluate the effects of the program. The results from both groups were compared. The results from eight patients in the intervention group and five in the non-intervention group were analyzed. FaceReader™ revealed a higher "Happy" index and lower "Sad" index in the intervention group than in the non-intervention group, and a significant interaction "Happy" index by an analysis of variance was noted between the two groups. EMG also showed increases in the activity of facial muscles in the intervention group. The subjects' mood improved after each facial rehabilitation exercise session. The results of the present study suggest that the facial rehabilitation exercise affected the mood, facial expression, and facial muscle activities in patients with PD and indicate that the expression analysis with the FaceReader™ and surface EMG are useful for evaluating the effects of facial rehabilitation exercise.

Influence of Pharmacist Intervention on Re-Elevation of Glycated Hemoglobin for Diabetic Outpatients.

Purpose: The effect of pharmacist intervention on blood sugar control in diabetic outpatients in a pharmacist-managed clinic was studied by focusing on the re-elevation of the glycated hemoglobin (A1c) level defined as a continuous variable. Methods: A retrospective chart review was performed at the Mizushima Kyodo Hospital from April 2014 to March 2016. Of the 221 diabetic outpatients who were provided guidance by nurses and nutritional managers, 62 further consulted the pharmacist-managed clinic. The remaining 159 patients were enrolled in a nonintervention group. Finally, the data of 115 patients with A1c level of ≥7.5% and A1c re-elevation were extracted. Intergroup comparison was performed between the pharmacist intervention (n = 26) and nonintervention (n = 89) groups. In both the groups, the starting point (baseline) was the time when the A1c level of ≥7.5% was observed. Subsequent monitoring was performed once in every 3 months. The average cumulative level of A1c re-elevation (CARE) was compared between groups. Patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, and male and female patients were also compared. Furthermore, the number of days until the re-elevation of the A1c level from the baseline was also compared. Results: The CARE values were 0.89 ± 0.86% and 1.51 ± 1.25% in the pharmacist intervention and nonintervention groups, respectively, showing a significant difference (P = .0195). There were no significant differences between patients with A1c level of ≥8.0% and A1c level between 7.5% and 8.0%, or between males and females. The number of days until the re-elevation of A1c level from the baseline also showed no significant difference. Conclusion: Pharmacist intervention for diabetic outpatients in pharmacist-managed clinics significantly suppressed CARE when compared with effects of no intervention, and this could be useful for preventing the exacerbation of diabetes.

A Descriptive Revenue Analysis of a Wound-Center IR Collaboration to Treat Lower Extremity Venous Ulcers.

To describe the revenue from a collaboration between a dedicated wound care center and an interventional radiology (IR) practice for venous leg ulcer (VLU) management at a tertiary care center. This retrospective study included 36 patients with VLU referred from a wound care center to an IR division during the 10-month active study period (April 2017 to January 2018) with a 6-month surveillance period (January 2018 to June 2018). A total of 15 patients underwent endovascular therapy (intervention group), whereas 21 patients did not (nonintervention group). Work relative value units (wRVUs) and dollar revenue were calculated using the Centers for Medicare and Medicaid Services Physician Fee Schedule. Three sources of revenue were identified: evaluation and management (E&M), diagnostic imaging, and procedures. The pathway generated 518.15 wRVUs, translating to $37,522. Procedures contributed the most revenue (342.27 wRVUs, $18,042), followed by E&M (124.23 wRVUs, $8,881), and diagnostic imaging (51.65 wRVUs, $10,599). Intervention patients accounted for 86.7% of wRVUs (449.48) and 80.0% of the revenue ($30,010). An average of 33 minutes (38.3 hours total) and 2.06 hours (36.8 hours total) were spent on E&M visits and procedures, respectively. In this collaboration between the wound center and IR undertaken to treat VLU, IR and E&M visits generated revenue and enabled procedural and downstream imaging revenue.

The effect of remote ischemic conditioning on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage.

To explore the effect of remote ischemic conditioning (RIC) on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage. According to inclusion and exclusion standards, from October 2017 to June 2018, 30 consecutive patients of aneurysmal subarachnoid hemorrhage admitted to Intensive Care Unit, Department of Neurosurgery at Xuanwu Hospital, were given remote ischemic conditioning 5 times intervention to each patient within 7days, and blood coagulation function testing, including prothrombin activity (PTA), prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (Fib), D-dimer, and thromboelastogram (TEG, including R, K, Angle, MA, EPL, LY30, A, CI, G, and A30) were performed for each patient before and after the RIC intervention, as well as venous ultrasound monitoring before and after the RIC intervention for detection of deep vein thrombosis (DVT). Transcranial Doppler evaluation (TCD), including cerebral blood flow of bilateral ACA, MCA, PCA and intracranial segments of VA, as well as BA and the ratios of MCA cerebral blood flow/terminal segment of ipsilateral ICA cerebral blood flow, was performed before and after RIC intervention; and fresh infarction was evaluated by head CT or MRI recheck after RIC intervention. Thirty cases without RIC intervention of matched age, gender, and Hunt Hess grade with aneurysmal subarachnoid hemorrhage were selected to compare coagulation function and cerebral blood flow using TCD with RIC group. (1) Comparing the data before and after the RIC intervention, there was no significant difference for APTT, Fib, and D-dimer (P > 0.05), while PTA decreased and PT increased slightly after intervention as well as INR (P < 0.05) but all still in normal reference values. (2) Comparing the data before and after the RIC intervention, within TEG parameters, only the R value increased with significant difference (P< 0.05) but still in normal reference value, while K, Angle, MA, EPL, LY30, A, CI, G, and A30 had no significant difference (P > 0.05). (3) Comparing the data before and after the RIC intervention, DVT was not detected on the pressurized limbs of patients. (4) Comparing the data before and after the RIC intervention, the cerebral blood flow of bilateral MCA, L-ACA, L-VA, and BA increased (P < 0.05), while the elevation ranges were all in 25%, and the other parameters showed no significant difference. (5) Head CT or MRI showed no fresh cerebral infarction after the RIC intervention. (6) Compared with the group without RIC intervention, the coagulation function and the cerebral blood flow evaluated by TCD of the RIC group showed no statistical difference (P > 0.05) except APTT and D-dimer decreased after RIC but still in normal reference values. RIC showed no obvious effect on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage both after the intervention and compared with the non-intervention group. DVT was not detected on the pressurized limbs of patients and no fresh cerebral infarction was detected. This preliminary study confirmed the safety of RIC on blood coagulation function and cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage, and the application of RIC on patients with aneurysmal subarachnoid hemorrhage needs further study to confirm and validate the safety and effectiveness.

Lymphangiographic Interventions to Manage Postoperative Chylothorax.

BackgroundPostoperative chylothorax may be caused by iatrogenic injury of the collateral lymphatic ducts after thoracic surgery. Although traditional treatment could be considered in most cases, resolution may be slow. Radiological interventions have recently been developed to manage postoperative chylothorax. This study aimed to compare radiological interventions and conservative management in patients with postoperative chylothorax.MethodsWe retrospectively reviewed periprocedural drainage time, length of hospital stay, and nil per os (NPO) duration in 7 patients who received radiological interventions (intervention group [IG]) and in 9 patients who received conservative management (non-intervention group [NG]).ResultsThe baseline characteristics of the patients in the IG and NG were comparable; however, the median drainage time and median length of hospital stay after detection of chylothorax were significantly shorter in the IG than in the NG (6 vs. 10 days, p=0.036 and 10 vs. 20 days, p=0.025, respectively). NPO duration after chylothorax detection and total drainage duration were somewhat shorter in the IG than in the NG (5 vs. 7 days and 8 vs. 14 days, respectively).ConclusionThis study showed that radiological interventions reduced the duration of drainage and the length of hospital stay, allowing an earlier return to normal life. To overcome several limitations of this study, a prospective, randomized controlled trial with a larger number of patients is recommended.