Patients In Usual Care Group Research Articles

The efficacy of transitional care services in patients with transient ischemic attack: A retrospective cohort study.

Transient ischemic attack (TIA) carries a particularly high short-term risk of stroke, which is associated with brain dysfunction caused by a regional reduction in blood flow. Transitional care services present benefits in improving ischemic neurological function and decreasing the recurrence in patients with TIA. The purpose of this study was to investigate the effects of transitional care on clinical outcomes in patients hospitalized for TIA. We retrospectively collected data about 1288 patients with TIA from May 2017 to June 2019. Patients were divided into mild (n = 438), moderate (n = 420) and severe group (n = 430) accessed by age, blood pressure, type of TIA, and duration (ABCD2) score. Participants were patients hospitalized due to TIA, assigned to transitional care (n = 643) or usual care (n = 645), and followed up for 24 months. Physical function of patients was evaluated using the 6-minute walk test. We evaluated patient reach, implementation using hospital quality measures, hospital-level sustainability physical function, ischemic neurological score, composite quality indicator score, and recurrence of TIA between transitional care or usual care group. TIA patients in transitional care group had better physical function and quality indicator score, lower ischemic neurological score and recurrence of TIA, and shorter hospital stay than patients in usual care group. Results demonstrated that transitional care significantly improved the patients’ satisfaction compared to usual care. Patients in mild, moderate, and severe group presented more benefits than usual care clinical outcomes in patients hospitalized for TIA. Transitional care is associated with better functional status for patients with TIA.

ОСОБЛИВОСТІ ВЕДЕННЯ ХВОРИХ НА БРОНХІАЛЬНУ АСТМУВ ПЕРІОД ПАНДЕМІЇ КОРОНАВІРУСНОЇ ХВОРОБИ (COVID-19)

PECULIARITIES OF CLINICAL MANAGEMENT OF ASTHMA DURING CORONAVIRUS DISEASE (COVID-19) PANDEMIC L. I. Konopkina Abstract The review is dedicated to the problem of interrelations between asthma (A), COVID-19 and inhaled corticosteroid (ICS) therapy. According to Global Initiative for Asthma (GINA) long-term treatment with systemic corticosteroids may lead to significant immunosuppression. Potentially, this is associated with higher risk of incidence and severity of viral infections. That was the reason why WHO in the beginning of 2020 had not granted recommendation for using systemic corticosteroids in COVID-19 patients if not indicated for other causes (including A and COPD exacerbations, usually requiring short course of oral corticosteroids). In Spring 2021 GINA renewed its recommendations on COVID-19 in A patients considering the grade of A symptoms control. It was demonstrated that patients with well-controlled A (mild to moderate) were neither at higher risk of COVID-19 occurrence nor of its more severe course. The risk of death from COVID-19 was also not increased in patients with well-controlled A. Moreover, in A patients 50 years of age and older, regularly taking ICS and admitted to hospital due to COVID-19, the mortality rate was lower than in other hospitalized patients. Today, it is important to debate whether ICS may interfere with the possibility of getting infected by coronavirus. It is well known that budesonide is one of most often prescribed ICS molecule. Budesonide in vitro has demonstrated a potential antiviral effect against different types of SARS-CoV-2. There are several ongoing studies in vivo: NCT04416399 (Great Britain; completed), NCT04355637 (Spain), NCT04193878, NCT04377711 (USA), NCT04331470 (Iran), NCT04330 (South Korea). The results of STOIC study, organized and conducted by Oxford university scientists, are of special interest. It was demonstrated that outpatient use of budesonide in COVID-19 patients reduced the risk of hospitalization and emergency care utilization by 90 %. There was a statistically significant reduction in symptoms intensity and time to clinical cure. Interim results of PRINCIPLE study suggested that early treatment with inhaled budesonide shortetens recovery time by a median of three days (comparing with usual care). In Budesonide Turbohaler group 32 % patients reached sustain recovery within 14 days of randomization (comparing with 22 % of patients in usual care group). Conclusion. Despite interim character of presented clinical trials data in this review, use of inhaled budesonide in COVID-19 patients, from our point of view, may be considered in particular clinical cases after a obligatory discussion with the patient.

Can autonomy support have an effect on type 2 diabetes glycemic control? Results of a cluster randomized controlled trial

ObjectivesTo assess whether social support or autonomy support intervention for patients with type 2 diabetes can achieve glycemic control at the end of intervention, and to test whether the glycemic...

Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up.

The aim of the study was to investigate the effectiveness of the postoperative 12-month exercise program compared to usual care on disability and health-related quality of life (HRQoL) in patients after lumbar spine fusion surgery (LSF). Altogether, 98 patients with isthmic (31) or degenerative (67) spondylolisthesis were randomised to exercise therapy group (EG) (n=48) or usual care group (UCG) (n=50) 3months after LSF. EG patients had home-based progressive strength and aerobic training program for 12months. UCG patients received only oral and written instructions of exercises. Oswestry Disability Index (ODI) and HRQoL (RAND-36) were evaluated at the time of randomization, at the end of the intervention and 1year after intervention. The mean ODI score decreased from 24 (12) to 18 (14) in the EG and from 18 (12) to 13 (11) in the UCG during intervention (between-groups p=0.69). At 1-year follow-up, 25% of the EG and 28% of the UCG had an ODI score ≥20. No between-group differences in HRQoL change were found at any time point. The mean (95% CI) physical functioning dimension of the HRQoL improved by 10.0 (4.6-15.3) in the EG and by 7.8 (2.5-13.0) in the UCG. In addition, the role physical score improved by 20.0 (7.7-32.3) in the EG and by 16.4 (4.4-28.4) in the UCG during the intervention. The exercise intervention did not have an impact on disability or HRQoL beyond the improvement achieved by usual care. However, disability remained at least moderate in considerable proportion of patients.

Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer.

Background:Although exercise has been addressed as an adjuvant treatment for anxiety, depression and cancer-related symptoms, limited studies have evaluated the effectiveness of exercise in patients with lung cancer.Methods:We recruited 116 patients from a medical centre in northern Taiwan, and randomly assigned them to either a walking-exercise group (n=58) or a usual-care group (n=58). We conducted a 12-week exercise programme that comprised home-based, moderate-intensity walking for 40 min per day, 3 days per week, and weekly exercise counselling. The outcome measures included the Hospital Anxiety and Depression Scale and the Taiwanese version of the MD Anderson Symptom Inventory.Results:We analysed the effects of the exercise programme on anxiety, depression and cancer-related symptoms by using a generalised estimating equation method. The exercise group patients exhibited significant improvements in their anxiety levels over time (P=0.009 and 0.006 in the third and sixth months, respectively) and depression (P=0.00006 and 0.004 in the third and sixth months, respectively) than did the usual-care group patients.Conclusions:The home-based walking exercise programme is a feasible and effective intervention method for managing anxiety and depression in lung cancer survivors and can be considered as an essential component of lung cancer rehabilitation.

Abstract 2587: Standard Medical Management Is Associated With Improved Quality And Outcome Of Secondary Stroke Prevention In China

Background and objective: Although guidelines for secondary ischemic stroke have been developed, there is a gap between guidelines and real world. To investigate the current status of secondary ischemic stroke in China and improve the quality of stroke prevention, We design a recommended guideline based program (SMART trial) and implement it in clinic practice to evaluate the feasibility and efficacy of the program. Methods: We conducted a multicenter (47 centers), paralleled, randomized, open label, controlled trial. Patients were randomized to two groups: standard medical management group (SMART group) and usual care group. In SMART group, measures of intervention were chosen based on the stroke sub-type according to the TOAST classification. Advice were given to the patients on stroke prevention . In usual treatment group, measures of intervention were chosen by the physician according to his/her personal knowledge. The main outcomes were the proportion of the patient’s adherence to 5 recommended measures and proportion of patients achieving the treatment target over time, a composite measures (total number of measure performed divided by the total number of eligible patients) was calculated. Secondary outcome was the composite cardiovascular events including new onset ischemic stroke, acute coronary syndrome, new onset hemorrhage stroke, and all causes of deaths. Results: Three thousand eight hundred and twenty-one patientswere enrolled into the trial. 1795 patients in standard medical treatment group, 2026 patients in usual care group. Participation in SMART group was associated with improvements in 3 measures and 1 composite measures (one year follow up): antiplatelet agents use (81.1% versus 74.9% ), statins use (55.8% versus 32.9%), antihyperglycemic agents use ( 72.6% versus 66.9% )and composite measures (68.36% versus 58.33%).Increased proportion of patients achieving treatment target were noticed (18 months follow up): blood pressure <140/90mmHg(60.6% versus 42.9%), LDL-C <2.6mmol/L (11.4% versus 9%)and HbA1c≤ 7% ( 6% versus 4.8%). The composite cardiovascular events rate decreased (4.18% versus 4.84%). The cost in hospital reduced 4.66%. Conclusions: Standard medical management program was feasible and associated with improved quality and outcome in secondary ischemic stroke prevention. Large scale promotion of this program across China was warranted.

Long-Term Effects of a Psychological Group Intervention on Physical Exercise and Health: The MoVo Concept

Little is known about the long-term effects of group intervention programs targeting physical exercise. This paper reports on the effectiveness of MoVo-LISA, a theory-based (MoVo-concept) standardized intervention program. Participants are taught cognitive-behavioral strategies of goal-setting, action planning, barrier management, and self-monitoring. N = 220 in-patients of an orthopedic rehabilitation clinic were assigned to the usual care group (UCG) or the intervention group (IG) (quasi-experimental design). Assessments were conducted at 5 time points. At 12-month follow-up, level of exercise in the IG was 28.5 min/week higher than in the UCG (P = .05). Moreover, 50% of the IG was exercising for at least 60 min/week, but only 33% of the UCG (P = .01). During the 12 months after clinic discharge, patients of the IG reported the same low pain experience that they had reached at the end of the clinic stay, whereas UCG patients' pain experience slowly reincreased. Results provide evidence that intervention programs based on the MoVo concept lead to long-term improvement in exercise behavior and health status.

Reducción de la morbimortalidad cardiovascular tras un episodio cardiovascular agudo mediante el tratamiento intensivo de los factores de riesgo (proyecto MIRVAS)

In spite of publication of many guidelines, management of patients on secondary prevention of cardiovascular disease is still not appropriated. We design a randomized trial, in usual clinical practice conditions, to compare the results in cardiovascular morbimortality of intensive and integral management of cardiovascular risk factors (CVRF) management versus conventional care.We selected patients discharged between October 2002 and January 2004 who suffered an acute coronary syndrome with or without ST-segment elevation or a stroke, 247 patients that met inclusions criteria were randomized to intensive care of CVRF in a specific Internal Medicine outpatient clinic (n = 121) or usual care according to National Health Service recommendations (n = 126). A year after randomization, the percentage of patients who met CVRF control, treatment received and the number of cardiovascular events (cardiovascular death, acute coronary syndrome with or without ST-segment elevation, stroke, transient ischemic attack, revascularization, lower limb amputation, heart failure admission and sudden death) were revised.CVRF control was greater in patients assigned to intensive care. 74.1% of hypertensive patients assigned to this treatment were controlled vs 41.7% in the usual care group (relative risk [RR] = 1.78; 95% confidence interval [CI], 1.27-2-49); 70.2% of patients had low-densi-tiy lipoprotein cholesterol lower than 100 mg/dl vs 55.8% (RR = 1.26; 95% CI, 1.00-1.58) of patients in usual care group; 93.1% of diabetic patients had glycosylated haemoglobin lower than 7% vs. 57.1% (RR = 1.63; 95% CI, 1.11-2.39) in the usual care group. There were 12 cardiovascular events in the intensive care group vs 35 in the usual care group.Intensive management of CVRF leads to a better control of them and a reduction of the morbimortality one year after an acute cardiovascular event.

Randomized Trial to Improve Prescribing Safety in Ambulatory Elderly Patients

To determine whether a computerized tool that alerted pharmacists when patients aged 65 and older were newly prescribed potentially inappropriate medications was effective in decreasing the proportion of patients dispensed these medications. Prospective, randomized trial. U.S. health maintenance organization. All 59,680 health plan members aged 65 and older were randomized to intervention (n=29,840) or usual care (n=29,840). Pharmacists received alerts on all patients randomized to intervention who were newly prescribed a targeted medication. Prescription and age information were linked to alert pharmacists when a patient aged 65 and older was newly prescribed one of 11 medications that are potentially inappropriate in older people. Physicians and pharmacists collaborated to develop the targeted medication list, indications for medication use for which an intervention should occur, intervention guidelines and scripts, and to implement the intervention. Over the 1-year study, 543 (1.8%) intervention group patients aged 65 and older were newly dispensed prescriptions for targeted medications, compared with 644 (2.2%) usual care group patients (P=.002). For medication use indications in which an intervention should occur, dispensings of amitriptyline (P<.001) and diazepam (P=.02) were reduced. This study demonstrated the effectiveness of a computerized pharmacy alert system plus collaboration between healthcare professionals in decreasing potentially inappropriate medication dispensings in elderly patients. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can improve prescribing safety in patients aged 65 and older.

Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care

ObjectivesThis study compared the effectiveness and cost/utility ratio between a heart failure (HF) management program delivered by day-hospital (DH) and usual care in chronic heart failure (CHF) outpatients. BackgroundPrevious studies showed that about 50% of readmissions for CHF can be prevented by a multidisciplinary approach However, the performance, effectiveness, and cost/utility ratio of a process of HF outpatient management related to evidence-based medicine have not been considered. MethodsA total of 234 prospective patients discharged by a HF Unit were randomized to two management strategies: 122 patients to usual community care and 112 patients to a HF management program delivered by the DH. Management (rate of readmissions, therapeutic interventions), functional parameters (New York Heart Association [NYHA] functional class, left ventricular diameters, and ejection fraction, deceleration time of early diastolic mitral flow, peak oxygen uptake, and mitral regurgitation) and hard outcomes (cardiac death and urgent cardiac transplantation) were evaluated. The cost/utility ratios of the two strategies were compared. ResultsAfter 12 ± 3 months of follow-up, the individual rate access in DH was 5.5 ± 3.8 days. The DH subjects were readmitted to the hospital less frequently than were the usual-care group patients (13 vs. 78, p < 0.00001). Patients allocated to usual-care management showed heterogeneous changes in NYHA functional class (13% improved and 16% worsened p = NS); In contrast, the DH group showed significant changes in NYHA functional class (23% improved and 11% worsened, p < 0.009). Hard cardiac events in the one-year follow-up occurred in 25/234 (10.6%) patients; cardiac death occurred in 21/122 (17.2%) of the community group and in 3/112 (2.7%) in the DH group (p < 0.0007). One DH patient underwent urgent transplantation. Comparison of the two managerial models by Cox regression analysis showed that DH management significantly protected against the appearance of hard events (relative risk [RR] 0.17; confidence interval [CI] 0.06 to 0.66). The cost/utility ratio of the two management strategies was similar (usual care $2,409 vs. DH $2,244). The incremental analysis revealed a cost savings of $1,068 for each quality-adjusted life year gained. The cost/utility ratio for the integration of DH management of CHF was $19,462 (CI $13,904 to $34,048). ConclusionsA heart failure outpatient management program delivered by a DH can reduce mortality and morbidity of CHF patients. This management strategy is cost-effective and has an equitable value from a societal point of view.