BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safel...BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.展开更多
Title Page The title page(page 1,do not number)should contain these elements:(a)full title;(b)Each authors'names,academic degrees,and affiliations(if Chinese,give standard English version);(c)the designated corres...Title Page The title page(page 1,do not number)should contain these elements:(a)full title;(b)Each authors'names,academic degrees,and affiliations(if Chinese,give standard English version);(c)the designated corresponding author's name,mailing address,telephone and fax numbers,and e-mail address;(d)source(s)of financial support of the study;(e)the total word count of the manuscript,including the title page,abstract,text,references,tables,and figures legends.展开更多
AIM: To investigate the effects of daily telephonebased re-education(TRE) before taking medicine for the eradication of Helicobacter pylori(H. pylori) on the compliance and the eradication rate in a Chinese patient po...AIM: To investigate the effects of daily telephonebased re-education(TRE) before taking medicine for the eradication of Helicobacter pylori(H. pylori) on the compliance and the eradication rate in a Chinese patient population.METHODS : Aprospective, physician-blind e d, randomized, controlled clinical study was conducted. The patients were randomly assigned to receive TRE every day before taking medicine(TRE group) or no TRE(control group). The patients in the TRE group received regular instructions before taking medicine for the eradication of H. pylori during the entire courseof treatment through telephone calls. The patients in the control group received detailed instructions at the time of seeing a doctor for the guidance. The primary outcome was the H. pylori eradication rate after treatment. The secondary outcomes included the clinical remissions after treatment, adverse events, compliance, and patients' satisfaction.RESULTS: A total of 140 patients were randomized, 70 to the TRE group and 70 to the control group. As the primary outcome, the H. pylori eradication rates in the TRE and control groups were 62.7% and 71.2% in per protocol analysis(P = 0.230), and 52.9% and 52.9% in intention-to-treat analysis(P = 0.567), respectively. As the secondary outcomes, there were no significant differences in the patients' satisfaction between the two groups(good, 79.7% vs 76.9%; fair, 13.6% vs 19.2%; poor, 6.7% vs 3.9%, for the TRE group and control group, respectively; P > 0.05 for all); the rates of adverse effects were 15.2% and 63.5% in the TRE and control groups, respectively(P < 0.001); the compliance rates in the TRE and control groups were 85.7% and 74.3%, respectively(P = 0.069).CONCLUSION: Daily TRE before taking medicine had no significant impact on the patients' compliance, satisfaction, or H. pylori eradication, but reduced the rate of adverse events.展开更多
Objective: To compare the efficacy of a short messaging service (SMS) text messaging and phone reminder to im-prove attendance rates at a health promotion center. Methods: A total of 1 859 participants who had schedul...Objective: To compare the efficacy of a short messaging service (SMS) text messaging and phone reminder to im-prove attendance rates at a health promotion center. Methods: A total of 1 859 participants who had scheduled appointments in the health promotion center of our hospital from April 2007 to May 2007 were enrolled in the study and randomly assigned into 3 groups: control (no reminder) group,SMS text messaging reminder group and telephone reminder group. Attendance rates and costs of interventions were collected. Results: A total of 1848 participants were eligible for analysis. Attendance rates of control,SMS and telephone groups were 80.5%,87.5% and 88.3%,respectively. The attendance rates were significantly higher in SMS and telephone groups than that in the control group,with odds ratio 1.698,95% confidence interval 1.224 to 2.316,P=0.001 in the SMS group,and odds ratio 1.829,95% confidence interval 1.333 to 2.509,P<0.001 in the telephone group. However,there was no difference between the SMS group and the telephone group (P=0.670). The cost effectiveness analysis showed that the cost per attendance for the SMS group (0.31 Yuan) was significantly lower than that for the telephone group (0.48 Yuan). Conclusion: SMS and telephone are effective reminders for improving attendance rate at a health promotion center. SMS reminder may be more cost-effective compared with the telephone reminder.展开更多
BACKGROUND:To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation(CPR)guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation.METHOD...BACKGROUND:To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation(CPR)guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation.METHODS:It was a prospective,blind,randomised controlled study involving 109 medical students without previous CPR training.In a standardized mannequin scenario,after the step of dispatcher-assisted cardiac arrest recognition,the participants performed compression-only resuscitation guided over the telephone by either:(1)the pre-recorded instructional audio(n=57);or(2)verbal dispatcher assistance(n=52).The simulation video records were reviewed to assess the CPR performance using a 13-item checklist.The interval from call reception to the first compression,total number and rate of compressions,total number and duration of pauses after the first compression were also recorded.RESULTS:There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score(5.6±2.2 vs.5.1±1.9,P>0.05)or individual criteria of the CPR performance checklist.The recording-assisted group demonstrated provided(170.2±48.0 vs.156.2±60.7).CONCLUSION:When provided by untrained persons in the simulated settings,the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR.Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.展开更多
Working memory(WM)maintains information temporarily for subsequent goal-directed behaviors,such as remembering a telephone number to dial.WM serves as a supporting mental workspace for many cognitive functions such as...Working memory(WM)maintains information temporarily for subsequent goal-directed behaviors,such as remembering a telephone number to dial.WM serves as a supporting mental workspace for many cognitive functions such as mental calculation,reading,and learning new skills.The critical role of persistent activity in the prefrontal cortex in WM,originally proposed to bridge sensory information and motor responses[1],has been severely debated recently[2,3].展开更多
Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with...Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital– community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire. Results: For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05) Conclusions: Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.展开更多
We read the article "Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori(H. pylori) eradication: A prospective singlecenter study from China" written by Wang et al wit...We read the article "Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori(H. pylori) eradication: A prospective singlecenter study from China" written by Wang et al with great interest. It is reported in American and European guidelines that there is no sufficient test for the diagnosis of H. pylori except culture and that using at least two different tests for diagnosis of H. pylori is recommended. Patients who used antibiotics or bismuth salts in the previous 2 wk were excluded from study. But patients who used probiotics and antioxidant vitamins such as vitamins C and E were not excluded.展开更多
BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained perso...BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was also a significant difference in compliance with preparedness protocols[bowel cleansing:IG 61.7%vs CG 52.6%(P=0.001),antithrombotic management:IG 92.5%vs CG 62.8%(P=0.001),and sedation scheduling:IG 78.8%vs CG 0%(P≤0.001)].We observed a net benefit of €55600/year after the intervention.The information given before the procedure was rated as excellent by 26%(CG)and 51%(IG)of patients,P≤0.001.CONCLUSION Educational telephone nurse intervention improves attendance,protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact,which supports its imple-mentation and maintenance over time.展开更多
文摘BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.
文摘Title Page The title page(page 1,do not number)should contain these elements:(a)full title;(b)Each authors'names,academic degrees,and affiliations(if Chinese,give standard English version);(c)the designated corresponding author's name,mailing address,telephone and fax numbers,and e-mail address;(d)source(s)of financial support of the study;(e)the total word count of the manuscript,including the title page,abstract,text,references,tables,and figures legends.
基金National Natural Science Foundation of China,No.81171526 and No.81472006
文摘AIM: To investigate the effects of daily telephonebased re-education(TRE) before taking medicine for the eradication of Helicobacter pylori(H. pylori) on the compliance and the eradication rate in a Chinese patient population.METHODS : Aprospective, physician-blind e d, randomized, controlled clinical study was conducted. The patients were randomly assigned to receive TRE every day before taking medicine(TRE group) or no TRE(control group). The patients in the TRE group received regular instructions before taking medicine for the eradication of H. pylori during the entire courseof treatment through telephone calls. The patients in the control group received detailed instructions at the time of seeing a doctor for the guidance. The primary outcome was the H. pylori eradication rate after treatment. The secondary outcomes included the clinical remissions after treatment, adverse events, compliance, and patients' satisfaction.RESULTS: A total of 140 patients were randomized, 70 to the TRE group and 70 to the control group. As the primary outcome, the H. pylori eradication rates in the TRE and control groups were 62.7% and 71.2% in per protocol analysis(P = 0.230), and 52.9% and 52.9% in intention-to-treat analysis(P = 0.567), respectively. As the secondary outcomes, there were no significant differences in the patients' satisfaction between the two groups(good, 79.7% vs 76.9%; fair, 13.6% vs 19.2%; poor, 6.7% vs 3.9%, for the TRE group and control group, respectively; P > 0.05 for all); the rates of adverse effects were 15.2% and 63.5% in the TRE and control groups, respectively(P < 0.001); the compliance rates in the TRE and control groups were 85.7% and 74.3%, respectively(P = 0.069).CONCLUSION: Daily TRE before taking medicine had no significant impact on the patients' compliance, satisfaction, or H. pylori eradication, but reduced the rate of adverse events.
基金Project supported by the Health Promotion Center of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China
文摘Objective: To compare the efficacy of a short messaging service (SMS) text messaging and phone reminder to im-prove attendance rates at a health promotion center. Methods: A total of 1 859 participants who had scheduled appointments in the health promotion center of our hospital from April 2007 to May 2007 were enrolled in the study and randomly assigned into 3 groups: control (no reminder) group,SMS text messaging reminder group and telephone reminder group. Attendance rates and costs of interventions were collected. Results: A total of 1848 participants were eligible for analysis. Attendance rates of control,SMS and telephone groups were 80.5%,87.5% and 88.3%,respectively. The attendance rates were significantly higher in SMS and telephone groups than that in the control group,with odds ratio 1.698,95% confidence interval 1.224 to 2.316,P=0.001 in the SMS group,and odds ratio 1.829,95% confidence interval 1.333 to 2.509,P<0.001 in the telephone group. However,there was no difference between the SMS group and the telephone group (P=0.670). The cost effectiveness analysis showed that the cost per attendance for the SMS group (0.31 Yuan) was significantly lower than that for the telephone group (0.48 Yuan). Conclusion: SMS and telephone are effective reminders for improving attendance rate at a health promotion center. SMS reminder may be more cost-effective compared with the telephone reminder.
文摘BACKGROUND:To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation(CPR)guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation.METHODS:It was a prospective,blind,randomised controlled study involving 109 medical students without previous CPR training.In a standardized mannequin scenario,after the step of dispatcher-assisted cardiac arrest recognition,the participants performed compression-only resuscitation guided over the telephone by either:(1)the pre-recorded instructional audio(n=57);or(2)verbal dispatcher assistance(n=52).The simulation video records were reviewed to assess the CPR performance using a 13-item checklist.The interval from call reception to the first compression,total number and rate of compressions,total number and duration of pauses after the first compression were also recorded.RESULTS:There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score(5.6±2.2 vs.5.1±1.9,P>0.05)or individual criteria of the CPR performance checklist.The recording-assisted group demonstrated provided(170.2±48.0 vs.156.2±60.7).CONCLUSION:When provided by untrained persons in the simulated settings,the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR.Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.
基金We gratefully acknowledge the support of the National Social Science Foundation of China(17ZDA323)the Shanghai Committee of Science and Technology(19ZR1416700,18JC1420304,18140901700)and Shanghai Clinical Research Center for Mental Health(19MC1911100).
文摘Working memory(WM)maintains information temporarily for subsequent goal-directed behaviors,such as remembering a telephone number to dial.WM serves as a supporting mental workspace for many cognitive functions such as mental calculation,reading,and learning new skills.The critical role of persistent activity in the prefrontal cortex in WM,originally proposed to bridge sensory information and motor responses[1],has been severely debated recently[2,3].
基金supported by Jiangsu Provincial Commission of Health and Family Planning(No.H2015032)Yancheng Commission of Health and Family Planning(No.YK2017010)
文摘Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital– community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire. Results: For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05) Conclusions: Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.
文摘We read the article "Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori(H. pylori) eradication: A prospective singlecenter study from China" written by Wang et al with great interest. It is reported in American and European guidelines that there is no sufficient test for the diagnosis of H. pylori except culture and that using at least two different tests for diagnosis of H. pylori is recommended. Patients who used antibiotics or bismuth salts in the previous 2 wk were excluded from study. But patients who used probiotics and antioxidant vitamins such as vitamins C and E were not excluded.
基金Supported by Hospital del Mar,Parc de Salut Mar.
文摘BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was also a significant difference in compliance with preparedness protocols[bowel cleansing:IG 61.7%vs CG 52.6%(P=0.001),antithrombotic management:IG 92.5%vs CG 62.8%(P=0.001),and sedation scheduling:IG 78.8%vs CG 0%(P≤0.001)].We observed a net benefit of €55600/year after the intervention.The information given before the procedure was rated as excellent by 26%(CG)and 51%(IG)of patients,P≤0.001.CONCLUSION Educational telephone nurse intervention improves attendance,protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact,which supports its imple-mentation and maintenance over time.