Telephone Reminders Research Articles

Feasibility of weekly participant-reported data collection in a pragmatic randomised controlled trial in primary care: experiences from the BATHE trial (Bath Additives for the Treatment of cHildhood Eczema)

BackgroundPatient-reported outcomes measures in clinical trials ensure that evaluations of effectiveness focus on outcomes that are important to patients. In relapsing-remitting conditions, such as eczema, repeated measurements may allow a more accurate reflection of disease burden and treatment effect than less frequent measurements.We asked parents/carers of children with eczema taking part in a trial of bath emollients to complete weekly questionnaires for 16 weeks.MethodsThe objective of this study was to determine the acceptability and practicality of collecting weekly measures of eczema severity online for 16 weeks in children aged 1 to 11 years as part of the BATHE study.BATHE randomised patients to bath emollients plus standard eczema care or standard eczema care only. The primary outcome was eczema severity, measured by the seven-item Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Acceptability was explored through qualitative interviews with 10 participants. Interviews were audio-recorded, transcribed and analysed thematically. Practicality was assessed by exploring the completeness of the data and keeping a log of any problems.ResultsFour hundred and eighty-two participants were recruited to the trial and 429 opted to complete measures online (89.0%). Data were collected online for 83% of time points over the 16-week period and there was no association between socio-demographic characteristics and data completeness. Two hundred and six (48%) completed their weekly data every week for 16 weeks and 341 (79%) completed it at least 80% of the time. The mean number of weeks completed was 13.3 out of 16 (SD 4.2).Interviewees said that they understood the rationale behind weekly collection and some welcomed this as it helped them realise how their child’s eczema changed weekly. Whilst some interviewees spoke of weekly questionnaires as onerous, others said that they found them quick and easy. Reminders were welcomed.Parents/carers seemed happy to receive telephone reminders and it was sometimes useful for eliciting problems relating to obtaining trial medication or password problems for online data collection.ConclusionsAmongst this population, high levels of data completeness suggests that weekly completion of the online questionnaire appears to be acceptable and feasible over a 16-week period.Trial registrationISRCTN84102309. Registered on 9 December 2013.

IMPROVING LUNG CANCER SCREENING RATES IN AN UNDERSERVED OUTPATIENT CLINIC

SESSION TITLE: Lung Cancer Screening: New Questions and New Answers SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 08:45 AM - 09:45 AM PURPOSE: Improve lung cancer screening ratesEducate residents and staff on the USPSTF lung cancer screening criteria METHODS: Lung cancer is the leading cause of cancer death worldwide and in the United States. Despite its massive mortality, no screening method was available until this decade. The National Lung Cancer Screening Trial (NLST) demonstrated in 2011 that lung cancer screening in high risks patients using low dose chest computed tomography (LDCT) resulted in a 20% relative reduction in lung cancer-related mortality compared to chest X-Ray screening. Hence, the USPSTF recommended (grade B) in December 2013 annual LDCT for lung cancer screening in adults age 55-80 years, who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.We performed a retrospective review of current and former smokers evaluated by a primary care provider over a six month period in 2017 in our inner city community health center. Patients that met the USPSTF criteria for lung cancer screening were selected and data regarding LDCT ordering and completion was collected. Microsoft Excel was used for data tabulation and analysis. We aim to improve our screening compliance by 20% in 6 months by implementing electronic medical records reminders, staff educational sessions, and telephone reminders to patients. RESULTS: 577 patients were identified and total of 108 patients met the USPSTF criteria for screening. A total of 287 patients (49%) were excluded as the numbers of pack per year were unable to be calculated. Of the 108 patients, 67% were current smoker and 33% former smokers. The mean age was 65 with 54% male and 46% female. A total of 57% of the patients identified as Hispanic or Latino and 70% of the patients selected English as their primary language. A LDCT was ordered by a physician in 32% (N=35) of cases and completed in only 18 patients, resulting in a net rate of screening compliance of 17%. Among those ordered, 17 patients (48.5%) did not complete their LDCT due to multiple reasons. The most common reaston of not completing LDCT was no missing/no-show to their appointment (73% of cases). Other reasons included insurance denial in 12%, or patient cancellation or re-scheduling in 12%. CONCLUSIONS: By highlighting our poor adherence to lung cancer screening guidelines, we hope to provide improvement to our screening rates and provide a valuable approach for other institutions. CLINICAL IMPLICATIONS: Lung cancer screening with low-dose CT yielded a 20% reduction in lung cancer mortality. In our study a total of 49% of the patients were excluded due to incomplete electronic medial record documentation. By addressing the importance of documentation to residents and staffs, a substantial number of patients can benefit from this screening. Also, addressing the higher number of no-show appointments can improve the compliance of lung cancer screening. DISCLOSURES: No relevant relationships by Carlos Rodriguez-Bonilla, source=Web Response No relevant relationships by Alan Tso, source=Web Response No relevant relationships by ANA VELAZQUEZ MANANA, source=Web Response

Impact of Quality Improvement Program on Expressed Breastmilk Usage in Very Low Birth Weight Infants

To improve the usage of expressed breast milk in very low birth weight infants admitted in the neonatal intensive care unit of a tertiary centre in India. Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas like antenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth, standardization of Kangaroo mother care, and non-nutritive sucking protocol. Data was analyzed using statistical process control charts. 156 very low birth weight infants were delivered during the study period, of which 31 were excluded due to various reasons. Within 6 months of implementation, the proportion of very low birth weight infants who received expressed breast milk within 48 hours improved to 100% from 38.7% and this was sustained at 100% for next 8 months. The mean time of availability and volume of expressed breast milk within 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7 mL to 15.8 mL, respectively. The mean proportion of expressed breast milk once infant reached a feed volume of 100 mL/kg/day also improved from 61.3% to 82.3%. Quality improvement interventions showed promising results of increased expressed breast milk usage in very low birth weight infants.

Changing household dietary behaviours through community-based networks: A pragmatic cluster randomized controlled trial in rural Kerala, India.

Trial designWith the rise in prevalence of non-communicable diseases in India and Kerala in particular, efforts to develop lifestyle interventions have increased. However, contextualised interventions are limited. We developed and implemented contextualised behavioural intervention strategies focusing on household dietary behaviours in selected rural areas in Kerala and conducted a community-based pragmatic cluster randomized controlled trial to assess its effectiveness to increase the intake of fruits and vegetables at individual level, and the procurement of fruits and vegetables at the household level and reduce the consumption of salt, sugar and oil at the household level.MethodsSix out of 22 administrative units in the northern part of Thiruvananthapuram district of Kerala state were selected as geographic boundaries and randomized to either intervention or control arms. Stratified sampling was carried out and 30 clusters comprising 6–11 households were selected in each arm. A cluster was defined as a neighbourhood group functioning in rural areas under a state-sponsored community-based network (Kudumbasree). We screened 1237 households and recruited 479 (intervention: 240; control: 239) households and individuals (male or female aged 25–45 years) across the 60 clusters. 471 households and individuals completed the intervention and end-line survey and one was excluded due to pregnancy. Interventions were delivered for a period of one-year at household level at 0, 6, and 12 months, including counselling sessions, telephonic reminders, home visits and general awareness sessions through the respective neighbourhood groups in the intervention arm. Households in the control arm received general dietary information leaflets. Data from 478 households (239 in each arm) were included in the intention-to-treat analysis, with the household as the unit of analysis.ResultsThere was significant, modest increase in fruit intake from baseline in the intervention arm (12.5%); but no significant impact of the intervention on vegetable intake over the control arm. There was a significant increase in vegetable procurement in the intervention arm compared to the control arm with the actual effect size showing an overall increase by19%; 34% of all households in the intervention arm had increased their procurement by at least 20%, compared to 17% in the control arm. Monthly household consumption of salt, sugar and oil was greatly reduced in the intervention arm compared to the control arm with the actual effect sizes showing an overall reduction by 45%, 40% and 48% respectively.ConclusionsThe intervention enabled significant reduction in salt, sugar and oil consumption and improvement in fruit and vegetable procurement at the household level in the intervention arm. However, there was a disconnect between the demonstrated increase in FV procurement and the lack of increase in FV intake. We need to explore fruit and vegetable intake behaviour further to identify strategies or components that would have made a difference. We can take forward the lessons learned from this study to improve our understanding of human dietary behaviour and how that can be changed to improve health within this context.

Effectiveness of reminder strategies on cancer screening adherence: a randomised controlled trial.

Few randomised controlled trials (RCTs) have evaluated the different recalling approaches for enhancing adherence to faecal immunochemical test (FIT)-based screening. The authors evaluated the effectiveness of two telecommunication strategies on improving adherence to yearly FIT screening. A randomised, parallel group trial was performed in a primary care screening practice. The authors recruited 629 asymptomatic individuals aged 40-70 years with a negative FIT in 2015 to a population-based screening programme. On participation, they were invited to repeat their second round of FIT in 2016, 12 months after the first test. Each participant was randomly assigned to either interactive telephone reminder (n = 207), short message service reminder (SMS, n = 212), or control, where no additional interventions were delivered after the findings of their first FIT was communicated to the participants (n = 210). Reminders in the intervention groups were delivered 1 month before subjects' expected return. Additional telephone reminders were delivered 2 months after the expected return date to all subjects who defaulted specimen return. The outcomes included rates of FIT collection and specimen return up to 6 months after their expected return. At 6 months, the cumulative FIT collection rate was 95.1%, 90.4%, and 86.5%, respectively, for the telephone, SMS, and control groups (P = 0.010). The corresponding specimen return rate was 94.1%, 90.0%, and 86.0% (P = 0.022). When compared with the control, only subjects in the telephone group were significantly more likely to collect FIT tubes (adjusted odds ratio [AOR] 3.18, 95% confidence interval [CI] = 1.50 to 6.75, P = 0.003) and return completed specimens (AOR = 2.73, 95% CI = 1.35 to 5.53, P = 0.005). Interactive telephone reminders are effective at securing previously screened subjects to repeat screening 1 year after a negative finding.

Exploring Reminder Calls Intended to Increase Interviewer Compliance with Data Collection Protocols

Survey managers sometimes require field interviewers to adhere to novel data collection protocols, which they may not consistently implement for a variety of reasons. This research examines whether automated reminder telephone calls encourage interviewers to perform such new instructions. Our findings suggest that calls may be related to interviewer compliance. The calls are inexpensive compared to other forms of training and supervision. We suggest that investigators explore the use of reminder calls when asking interviewers to implement unfamiliar data collection techniques.

Telemedicine Cost-Effectiveness for Diabetes Management: A Systematic Review.

Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness. A literature search was performed in 10 databases from inception until February 2018. All economic evaluations assessing the economic evaluation of telemedicine in diabetes were eligible for inclusion. We subsequently evaluated the study quality in terms of effectiveness measures, cost measure, economic model, as well as time horizon. Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers' fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost-effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management. Among all telemedicine strategies examined, teleophthalmology was the most cost-effective intervention. Future research is needed to provide evidence on the long-term experience of telemedicine and facilitate resource allocation.

208 - Effectiveness of Volunteer-Delivered Telephone Reminders on Adherence to Colorectal Cancer Screening: A Randomized Controlled Trial

208 - Effectiveness of Volunteer-Delivered Telephone Reminders on Adherence to Colorectal Cancer Screening: A Randomized Controlled Trial

Development and validation of a survey instrument to measure factors that influence pharmacist adoption of prescribing in Alberta, Canada.

Objective:Study objectives were to develop a questionnaire to assess factors influencing pharmacists’ adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties.Methods:Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach’s alpha. Scale responses were described.Results:Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support from interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliability while the remaining six scales had strong evidence for reliability and validity.Conclusion:Through a multi-stage process, a survey instrument was developed to capture pharmacists’ perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists.

Strategies to improve recruitment to randomised trials.

Recruiting participants to trials can be extremely difficult. Identifying strategies that improve trial recruitment would benefit both trialists and health research. To quantify the effects of strategies for improving recruitment of participants to randomised trials. A secondary objective is to assess the evidence for the effect of the research setting (e.g. primary care versus secondary care) on recruitment. We searched the Cochrane Methodology Review Group Specialised Register (CMR) in the Cochrane Library (July 2012, searched 11 February 2015); MEDLINE and MEDLINE In Process (OVID) (1946 to 10 February 2015); Embase (OVID) (1996 to 2015 Week 06); Science Citation Index & Social Science Citation Index (ISI) (2009 to 11 February 2015) and ERIC (EBSCO) (2009 to 11 February 2015). Randomised and quasi-randomised trials of methods to increase recruitment to randomised trials. This includes non-healthcare studies and studies recruiting to hypothetical trials. We excluded studies aiming to increase response rates to questionnaires or trial retention and those evaluating incentives and disincentives for clinicians to recruit participants. We extracted data on: the method evaluated; country in which the study was carried out; nature of the population; nature of the study setting; nature of the study to be recruited into; randomisation or quasi-randomisation method; and numbers and proportions in each intervention group. We used a risk difference to estimate the absolute improvement and the 95% confidence interval (CI) to describe the effect in individual trials. We assessed heterogeneity between trial results. We used GRADE to judge the certainty we had in the evidence coming from each comparison. We identified 68 eligible trials (24 new to this update) with more than 74,000 participants. There were 63 studies involving interventions aimed directly at trial participants, while five evaluated interventions aimed at people recruiting participants. All studies were in health care.We found 72 comparisons, but just three are supported by high-certainty evidence according to GRADE.1. Open trials rather than blinded, placebo trials. The absolute improvement was 10% (95% CI 7% to 13%).2. Telephone reminders to people who do not respond to a postal invitation. The absolute improvement was 6% (95% CI 3% to 9%). This result applies to trials that have low underlying recruitment. We are less certain for trials that start out with moderately good recruitment (i.e. over 10%).3. Using a particular, bespoke, user-testing approach to develop participant information leaflets. This method involved spending a lot of time working with the target population for recruitment to decide on the content, format and appearance of the participant information leaflet. This made little or no difference to recruitment: absolute improvement was 1% (95% CI -1% to 3%).We had moderate-certainty evidence for eight other comparisons; our confidence was reduced for most of these because the results came from a single study. Three of the methods were changes to trial management, three were changes to how potential participants received information, one was aimed at recruiters, and the last was a test of financial incentives. All of these comparisons would benefit from other researchers replicating the evaluation. There were no evaluations in paediatric trials.We had much less confidence in the other 61 comparisons because the studies had design flaws, were single studies, had very uncertain results or were hypothetical (mock) trials rather than real ones. The literature on interventions to improve recruitment to trials has plenty of variety but little depth. Only 3 of 72 comparisons are supported by high-certainty evidence according to GRADE: having an open trial and using telephone reminders to non-responders to postal interventions both increase recruitment; a specialised way of developing participant information leaflets had little or no effect. The methodology research community should improve the evidence base by replicating evaluations of existing strategies, rather than developing and testing new ones.

Hypnosis Intervention Effects on Sleep Outcomes: A Systematic Review.

Sleep improvement is a promising target for preventing and modifying many health problems. Hypnosis is considered a cost-effective and safe intervention with reported benefits for multiple health conditions. There is a growing body of research assessing the efficacy of hypnosis for various health conditions in which sleep was targeted as a primary or secondary outcome. This review aimed to investigate the effects of hypnosis interventions on sleep, to describe the hypnotic procedures, and to evaluate potential adverse effects of hypnosis. We reviewed studies (prior to January 2017) using hypnosis in adults for sleep problems and other conditions comorbid with sleep problems, with at least one sleep outcome measure. Randomized controlled trials and other prospective studies were included. One hundred thirty-nine nonduplicate abstracts were screened, and 24 of the reviewed papers were included for qualitative analysis. Overall, 58.3% of the included studies reported hypnosis benefit on sleep outcomes, with 12.5% reporting mixed results, and 29.2% reporting no hypnosis benefit; when only studies with lower risk of bias were reviewed the patterns were similar. Hypnosis intervention procedures were summarized and incidence of adverse experiences assessed. Hypnosis for sleep problems is a promising treatment that merits further investigation. Available evidence suggests low incidence of adverse events. The current evidence is limited because of few studies assessing populations with sleep complaints, small samples, and low methodological quality of the included studies. Our review points out some beneficial hypnosis effects on sleep but more high-quality studies on this topic are warranted.

Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial

BackgroundPatients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors.MethodsThe Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) – m-CCRP intervention versus attention control. Those in the intervention group will meet with a care coordinator after hospital discharge in predetermined intervals to aid in the recovery process. Baseline assessments and personalized goal setting will be used to develop an individualized care plan for each patient after discussion with an interdisciplinary team. The attention control arm will receive printed material and telephone reminders emphasizing mobility and management of chronic conditions. Duration of the intervention and follow-up is 12 months post-randomization.Our primary aim is to assess the efficacy of m-CCRP in improving the quality of life of ARF survivors at 12 months. Secondary aims of the study are to evaluate the efficacy of m-CCRP in improving function (cognitive, physical, and psychological) of ARF survivors and to determine the efficacy of m-CCRP in reducing acute healthcare utilization.DiscussionThe proposed randomized controlled trial will evaluate the efficacy of a collaborative critical care recovery program in accomplishing the Institute of Healthcare Improvement’s triple aims of better health, better care, at lower cost. We have developed a collaborative critical care model to promote ARF survivors’ recovery from the physical, psychological, and cognitive impacts of critical illness. In contrast to a single disease focus and clinic-based access, m-CCRP represents a comprehensive, accessible, mobile, ahead of the curve intervention, focused on the multiple aspects of the unique recovery needs of ARF survivors.Trial registrationNCT03053245, clinicaltrials.gov, registered February 1, 2017.

Enhanced inpatient rounds, appointment reminders, and patient education improved HIV care engagement following hospital discharge.

Human immunodeficiency virus (HIV) care engagement post hospital discharge is often suboptimal. Strategies to improve follow-up are needed. A quasi-experimental study was conducted among hospitalized HIV-infected patients between the period from 1 January 2013 to 30 June 2014 (preintervention period) and 1 July 2014 to 31 December 2015 (intervention period). During the intervention period, an HIV care team consisting of an Infectious Diseases physician, a nurse, a pharmacist, a social worker, and an HIV-infected volunteer made daily inpatient rounds. Prior to discharge, patients received a structured HIV education session and an outpatient appointment was scheduled for them with two telephone reminder calls following discharge. There were 240 HIV-infected patients enrolled (120 in each study period), of which the median age was 37 years (interquartile range [IQR] 28-44 years), 58% were male, 39% were newly diagnosed with HIV infection, 46% were hospitalized because of AIDS-related conditions, and the median CD4 cell count on admission was 158 cells/µl (IQR 72-382 cells/µl). The rate of HIV care engagement within 30 days after discharge was significantly higher in the intervention period compared to the preintervention period (95% versus 69%; P < 0.001). Independent factors associated with no care engagement within 30 days were patients in the preintervention period (adjusted odds ratio [aOR] 6.36; P < 0.001) and new diagnosis of HIV infection (aOR 2.77; P = 0.009). The study findings suggest that enhanced inpatient rounds, appointment reminders, and patient education were shown to be associated with improved HIV care engagement after hospital discharge. Patients with a new diagnosis of HIV infection benefit from more intense outreach. ClinicalTrials.gov Identifier: NCT02578654.

Improving diabetes control in the community: a nurse managed intervention model in a multidisciplinary clinic

Objective: To assess diabetes management and control measures in a central multidisciplinary primary care clinic, conducted by a nurse. Design: A cross sectional study. Setting: Central, multidisciplinary, primary care clinic. Subjects: Randomly selected 100 people with diabetes. Interventions: People with diabetes with suspected non-optimal glucose control (HbA1c &gt; 7%), were invited to the clinic nurse to discuss optimal personal diabetes control, treatment and follow up. All were provided the necessary referrals to consultants and were called in for follow up visits, and received telephone reminders. All interventions were made according to the current American Diabetes Association Standards of Medical Practice recommendations. Main outcome measures: Retrospective data were collected. Data included demographics and diabetes control measures (e.g. HbA1c, LDL, blood pressure, ophthalmologic examination etc.). Data was collected for three x 6 months periods: 1) six months before the nurse visit; 2) six months following the first nurse visit (the intervention); and 3) for patients who were followed up for at least one year after the intervention, the last six months of follow-up. Results: With a median follow up of 25 months, HbA1c, LDL and systolic blood pressure levels dropped significantly from before starting the clinic through the intervention and remained low in the last half year of follow up. GP, Ophthalmologist and Dietician visits increased significantly during the study. Non-significant trends were observed with total and diabetes-related hospitalisations decreased, foot examination rates increased and mild weight loss. Conclusion: Multidisciplinary intervention managed by a nurse, improve diabetes management and control measures. Observed changes persisted after the intervention period. A cross sectional study.

Comparative impact of nonpharmacological interventions on pain of knee osteoarthritis patients reporting at a tertiary care institution: A randomized controlled trial

Context:Nonpharmacological interventions (NPIs) have been advocated for knee osteoarthritis (KOA). There are many gaps in the evidence to their efficacy in India.Aims:The study aims to compare the impact of two packages of NPIs on various outcome variables of KOA patients.Settings and Design:This was a randomized controlled trial in a tertiary care hospital.Subjects and Methods:A study population (n = 123) of KOA patients aged 40–65 years. Stratified block randomization was done for mild or moderate KOA into two groups. Group “A” patients received a package of NPIs including a set of supervised exercise sessions, kinesthesia, balance, and agility (KBA), meditation, weight reduction advice, and weekly telephonic reminders. Group “B” patients received the same package except for KBA & meditation. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) and performance-based measures were measured.Analysis:t-test and repeat measures ANOVA were undertaken.Results:A significant intragroup reduction in WOMAC score was seen from baseline in Group A (P = 0.00, mean difference: −9.7) as well as in Group B (P = 0.00, −12.9). There was also significant reduction inVAS scores at the end of intervention in Group A and Group B as compared from baseline (−3.62, −3.8, P = 0.00). No intergroup difference was observed in either of the scores. VAS score reduction to 0 at different stages of intervention was noticed in 46% (n = 57) cases. There was a significant intergroup difference for 50-Foot Walk Test (P = 0.055, F = 3.28) at 12 months.Conclusion:Both packages of NPIs were effective in providing relief in symptoms. No specific benefit of KBA or meditation was seen except for 50FWT.

Landscape of antimicrobial stewardship programs in Ontario: a survey of hospitals.

Antimicrobial resistance is an important public health issue globally and in Canada. To understand the current state of antimicrobial stewardship programs in Ontario health care facilities, Public Health Ontario conducted a voluntary survey of hospitals in the province. The Ontario Antimicrobial Stewardship Program Landscape Survey was distributed online to hospitals, targeting front-line antimicrobial stewardship clinicians. The survey was open for 5 weeks in fall 2016. We used email and telephone reminders to encourage response. We performed descriptive and inferential statistical analyses at an aggregate level and by hospital type. Mental health and ambulatory sites were excluded. The response rate was 74.0% (97/131 organizations). Of the 97, 90 (93%) reported having a formal antimicrobial stewardship program or were in the process of implementing a formal program. Just over half (50 [56%]) identified appropriate antibiotic use as part of the organization's quality-improvement plan, strategic goal or priority. Half (45 [50%]) of programs did not have designated resources; those that did are underresourced with respect to physician and pharmacist staffing. The scope of implementation of program strategies was variable. Fifty hospitals (56%) reported tracking antimicrobial expenditures, 47 (52%) reported tracking defined daily dose, and 35 (39%) reported tracking days of therapy. Most Ontario hospitals have a formal antimicrobial stewardship program, but there are opportunities for improvement. Future efforts should increase the priority of and improve resource allocation for antimicrobial stewardship programs so that programs can continue to grow in scope and impact.

Clinic attendance and disengagement of young adults with type 1 diabetes after transition of care from paediatric to adult services (TrACeD): a randomised, open-label, controlled trial

Care transition from paediatric to adult services for young adults with type 1 diabetes is frequently associated with decreased attendance at outpatient hospital clinics and increased disengagement from specialist services. We aimed to assess the effect of an appointment-management intervention on clinic attendance and disengagement after transition. We did a randomised, open-label, controlled trial of patients aged 17-19 years with type 1 diabetes. Participants were recruited from a tertiary paediatric diabetes service at the Royal Children's Hospital (Melbourne, VIC, Australia) and had to be scheduled for transition to adult services at one of eight centres in Melbourne. We randomly assigned participants (1:1), using sequential sealed opaque envelopes, to either appointment management (intervention) or current care (control). The appointment manager acted as the point of contact between intervention group participants and the relevant adult clinics, and provided personalised pre-appointment telephone and short message service (SMS) reminders with automatic rebooking of missed appointments. No contact was initiated with the control group after recruitment, and any self-initiated contact with the investigating team was directed to the participant's previous treating paediatric physician. The intervention continued throughout the trial until at least 12 months of follow-up data were obtained for all participants. We assessed the mean frequency of adult clinic attendance and disengagement from services during 0-12 months after transition (primary outcomes) and 12-24 months after transition (secondary outcomes), analysed by intention to treat. We used regression analyses, adjusted for clinic attendance and glycated haemoglobin concentration pre-transition, to analyse the effect of the intervention. This study is registered with the Australian New Zealand Clinical Trials Registry (number ACTRN12611001012965). Between Jan 4, 2012, and Dec 31, 2014, we randomly assigned 120 individuals, 60 to the intervention and 60 to control. During 0-12 months after transition, the mean number of clinics attended was 2·3 (SD 1·1) in the intervention group and 2·3 (1·4) in the control group (p=0·84; adjusted β 0·1, SE 0·2, p=0·88); three (6%) of 49 participants in the intervention group and six (11%) of 55 in the control group disengaged from services (p=0·38; adjusted odds ratio [OR] 0·5, 95% CI 0·1-2·3, p=0·36). At 12-24 months post-transition, mean clinic attendance was 2·5 (SD 1·3) in the intervention group and 1·4 (SD 1·8) in the control group (p=0·001; adjusted β 0·9, SE 0·4, p=0·009); two (6%) of 32 in the intervention group and 18 (49%) of 37 in the control group disengaged from services (p=0·001; adjusted OR 0·1, 95% CI 0·1-0·2, p=0·001). Neither the intervention nor pre-transition clinic attendance had an independent effect on glycated haemoglobin after transition. Appointment management did not increase clinic attendance and did not decrease disengagement with services 0-12 months after transition to adult services, but had a positive effect during 12-24 months after transition. Australasian Paediatric Endocrine Group and Lilly.

Identifying research priorities for effective retention strategies in clinical trials

BackgroundThe failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition.MethodsSeventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials.Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority.ResultsFifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice.Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact during a trial, the use of routinely collected data, the frequency and timing of reminders, triggered site training and the time needed to complete questionnaires was deemed critical. Research into the effectiveness of Christmas cards for site staff was not of critical importance.ConclusionThe surveys of current practices demonstrates that a variety of strategies are being used to mitigate missing data but with little evidence to support their use. Six retention strategies were deemed critically important within the Delphi survey and should be a primary focus of future retention research.

Text message reminders for improving patient appointment adherence in an office-based buprenorphine program: A feasibility study.

Missed visits are common in office-based buprenorphine treatment (OBOT). The feasibility of text message (TM) appointment reminders among OBOT patients is unknown. This 6-month prospective cohort study provided TM reminders to OBOT program patients (N = 93). A feasibility survey was completed following delivery of TM reminders and at 6 months. Respondents reported that the reminders should be provided to all OBOT patients (100%) and helped them to adhere to their scheduled appointment (97%). At 6 months, there were no reports of intrusion to their privacy or disruption of daily activities due to the TM reminders. Most participants reported that the TM reminders were helpful in adhering to scheduled appointments (95%), that the reminders should be offered to all clinic patients (95%), and favored receiving only TM reminders rather than telephone reminders (95%). Barriers to adhering to scheduled appointment times included transportation difficulties (34%), not being able to take time off from school or work (31%), long clinic wait-times (9%), being hospitalized or sick (8%), feeling sad or depressed (6%), and child care (6%). This study demonstrated the acceptability and feasibility of TM appointment reminders in OBOT. Older age and longer duration in buprenorphine treatment did not diminish interest in receiving the TM intervention. Although OBOT patients expressed concern regarding the privacy of TM content sent from their providers, privacy issues were uncommon among this cohort. Scientific Significance Findings from this study highlighted patient barriers to adherence to scheduled appointments. These barriers included transportation difficulties (34%), not being able to take time off from school or work (31%), long clinic lines (9%), and other factors that may confound the effect of future TM appointment reminder interventions. Further research is also required to assess 1) the level of system changes required to integrate TM appointment reminder tools with already existing electronic medical records and appointment records software; 2) acceptability among clinicians and administrators; and 3) financial and resource constraints to healthcare systems. (Am J Addict 2017;26:581-586).

Protocol for a single-centre, randomised controlled study of a preoperative rehabilitation bundle in the frail and elderly undergoing abdominal surgery

IntroductionFrail patients have decreased physiological reserves and consequently, they are unable to recover as quickly from surgery. Frailty, as an entity, is a risk factor of increased morbidity and mortality....