Controlled Trial of a Home and Ambulatory Program for Asthmatic Children

Care of asthmatic children is often episodic and more therapeutic than preventive. A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures. Interventions for the study group during the first year included 3-month clinic visits, education, and home visits by a specially trained research nurse. Control subjects continued to receive regular care from a family physician or pediatrician. Eighty-nine subjects (93%) completed the study. Study subjects had less school absenteeism than control subjects (10.7 vs. 16.0 days, P = .04) and showed significantly better small airway function after 1 year. Asthma severity improved in 13 study subjects and worsened in 5. The reverse was true for control subjects. Study subjects exhibited better metered aerosol technique than control subjects (P = .0005). Fewer days were spent in hospital by the study subjects admitted compared with control subjects (3.67 vs 11.2 days, P = .02). After 1 year, more study than control families (72.1% vs 33.1%, P = .006) reported that their asthmatic child took responsibility for the asthma management. The intervention failed to reduce exposure to secondhand smoke or to household pets. There were no significant differences in medical visits, theophylline levels, or records of asthma symptoms. One year after discontinuing the intervention, a marked "washout" effect was observed. Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.

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An Effectiveness Trial of STEADI in an Outpatient, Primary Care Practice

Innovation in Aging ◽

10.1093/geroni/igaa057.2799 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 774-774

Author(s):

David Rein ◽

Madeleine Hackney ◽

Michele Dougherty ◽

Camille Vaughan ◽

Laurie Imhof ◽

...

Keyword(s):

Primary Care ◽

Medication Review ◽

Primary Care Practice ◽

Controlled Trial ◽

Care Practice ◽

Strength Assessment ◽

Randomized Controlled ◽

Study Team ◽

One Year ◽

The Impact

Abstract The STEADI Options trial uses a randomized, controlled-trial design to assess the effectiveness and cost-effectiveness of the STEADI Initiative . Beginning March, 2020, we will randomize 3,000 adults ≥ 65 years of age at risk for falls seen in an Emory Clinic primary care practice to: (1) full STEADI; (2) a STEADI-derived gait, balance, and strength assessment with physical therapy referrals; (3) a STEADI-derived medication review and management; or (4) usual care. This presentation will discuss decisions made by the study team to facilitate implementation of STEADI including electronically conducting screening prior to the date of encounter, the use of dedicated nursing staff to conduct assessments, implementation of strength, balance, orthostatic hypotension, and vision testing, methods to facilitate medication review, and communication of assessment information to providers. The results from this study will be used to estimate the impact of STEADI on falls, service utilization, and costs over one year.

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Feasibility study of a communication and education asthma intervention for general practitioners in Australia

Australian Journal of Primary Health ◽

10.1071/py09056 ◽

2010 ◽

Vol 16 (1) ◽

pp. 75 ◽

Cited By ~ 10

Author(s):

Smita Shah ◽

Brett G. Toelle ◽

Susan M. Sawyer ◽

Jessica K. Roydhouse ◽

Peter Edwards ◽

...

Keyword(s):

General Practitioners ◽

Controlled Trial ◽

Communication Strategies ◽

Asthma Management ◽

Doctor Patient Communication ◽

Children With Asthma ◽

The Usa ◽

Randomised Controlled ◽

Communication Behaviours ◽

The Impact

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.

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Examining the Impact of the SDLMI and Whose Future Is It? Over a Two-Year Period With Students With Intellectual Disability

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-125.3.217 ◽

2020 ◽

Vol 125 (3) ◽

pp. 217-229 ◽

Cited By ~ 1

Author(s):

Karrie A. Shogren ◽

Tyler A. Hicks ◽

Kathryn M. Burke ◽

Anthony Antosh ◽

Terri LaPlante ◽

...

Keyword(s):

Controlled Trial ◽

Outcome Data ◽

Future Research ◽

First Year ◽

Opposite Pattern ◽

Nonlinear Growth ◽

Intensive Intervention ◽

Cluster Randomized ◽

One Year ◽

The Impact

Abstract The purpose of this study was to examine self-determination outcome data in the year following a one-year cluster randomized controlled trial (C-RCT) comparing the impacts of a Self-Determined Learning Model of Instruction (SDLMI) only condition to a SDLMI + Whose Future Is It? (SDLMI + WF) condition. Using multilevel B-spline model analysis with Bayesian estimation, we examined ongoing patterns of growth after the trial ended and all students were exposed to SDLMI + WF. The findings suggest that the inclusion of an additional year of outcome data provided additional insight into the impact of more intensive intervention conditions over time. Specifically, after the initial year of implementation, the SDLMI + WF condition predicted greater annual gains than the SDLMI only condition, unlike findings in the first year which reflected the opposite pattern. This evidence suggests a nonlinear growth pattern over multiple years of intervention with more intensive interventions. Implications for future research and practice are discussed.

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Emergency physicians as human billboards for injury prevention: a randomized controlled trial

CJEM ◽

10.1017/cem.2016.366 ◽

2016 ◽

Vol 19 (04) ◽

pp. 277-284 ◽

Cited By ~ 1

Author(s):

Emily Sullivan ◽

Daniel Fuller ◽

Quinten S. Paterson ◽

Shelby Huffman ◽

Satyadeva Challa ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Injury Prevention ◽

Controlled Trial ◽

Bicycle Helmet ◽

Emergency Physicians ◽

Helmet Use ◽

Randomized Controlled ◽

One Year ◽

Prevention Counselling ◽

The Impact

ABSTRACT Objectives The objective of this study was to evaluate the impact of a novel injury prevention intervention designed to prompt patients to initiate an injury prevention discussion with the ED physician, thus enabling injury prevention counselling and increasing bicycle helmet use among patients. Methods A repeated measures 2 x 3 randomized controlled trial design was used. Fourteen emergency physicians were observed for two shifts each between June and August 2013. Each pair of shifts was randomized to either an injury prevention shift, during which the emergency physician would wear a customized scrub top, or a control shift. The outcomes of interest were physician time spent discussing injury prevention, current helmet use, and self-reported change in helmet use rates at one year. Logistic regression analyses were used to examine the impact of the intervention. Results The average time spent on injury prevention for all patients was 3.3 seconds. For those patients who actually received counselling, the average time spent was 17.0 seconds. The scrub top intervention did not significantly change helmet use rates at one year. The intervention also had no significant impact on patient decisions to change or reinforcement of helmet use. Conclusions Our study showed that the intervention did not increase physician injury prevention counselling or self-reported bicycle helmet use rates among patients. Given the study limitations, replication and extension of the intervention is warranted.

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Impact of inaccuracy of peak flowmeters with Wright scale on asthma severity assessment in children

Medicinski pregled ◽

10.2298/mpns0808354s ◽

2008 ◽

Vol 61 (7-8) ◽

pp. 354-358 ◽

Cited By ~ 1

Author(s):

Dragana Stamatovic ◽

Nada Bokan-Erdeljan ◽

Milan Gajic ◽

Zorica Vujnovic-Zivkovic

Keyword(s):

European Union ◽

Asthma Management ◽

Asthma Severity ◽

Study Group ◽

Severity Assessment ◽

Objective Method ◽

Predictive Equation ◽

Asthmatic Children ◽

Before And After ◽

Daily Variability

Introduction Measurement of daily variability of peak expiratory flow (PEF) is widely accepted as an objective method to assess asthma severity. Recent investigations have proved nonlinearity of original Wright scale of peak flowmeter. All country members of European Union have been obliged to implement a new scale according to standard EN 13826 since 2005. This study examined whether the correction of PEF values for the inaccuracy of the scale would affect asthma management based on their daily variability. Material and methods We analyzed PEF values (2352) in 34 children, aged 5-16, during 3-5 weeks of monitoring in order to establish the diagnosis of asthma by using peak flowmeters with Write scale. The correction of measured values for inaccuracy was managed with original Dr M. Miller's predictive equation. The daily variability of PEF (amplitude percent mean) up to 20% was considered as 'normal', 20-29.9% as 'raised', and 30% and above as 'high'. The assessment of daily variability was performed before and after correction. Results There was no significant change in the number of days with airway liability as regarding the assessed whole study group (p=0.475). However, 22 (64.7%) of children had at least one false clinical message about daily variability during the monitoring. It was overestimated in 12 (7%) days in younger (6.6?0.8 years) or of shorter stature (122.6?3.6cm) and underestimated in 13 (4%) days in older (11.1?2.7) or taller ones (150.9?12.5 cm) (p<0.001). Conclusion Usage of peak flowmeters with Wright scale may lead to an error in asthma severity assessment based on daily variability of PEF. It may cause overtreatment or undertreatment of asthmatic children.

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Outpatient Management of Asthma in Children

Clinical Medicine Insights Pediatrics ◽

10.4137/cmped.s7867 ◽

2013 ◽

Vol 7 ◽

pp. CMPed.S7867 ◽

Cited By ~ 3

Author(s):

André Schultz ◽

Andrew C. Martin

Keyword(s):

Treatment Options ◽

Symptom Control ◽

Correct Diagnosis ◽

Asthma Management ◽

Asthma Severity ◽

Pediatric Health Care ◽

Asthma Symptoms ◽

Inhaled Therapy ◽

The Impact

The principal aims of asthma management in childhood are to obtain symptom control that allows individuals to engage in unrestricted physical activities and to normalize lung function. These aims should be achieved using the fewest possible medications. Ensuring a correct diagnosis is the first priority. The mainstay of asthma management remains pharmacotherapy. Various treatment options are discussed. Asthma monitoring includes the regular assessment of asthma severity and asthma control, which then informs decisions regarding the stepping up or stepping down of therapy. Delivery systems and devices for inhaled therapy are discussed, as are the factors influencing adherence to prescribed treatment. The role of the pediatric health care provider is to establish a functional partnership with the child and their family in order to minimize the impact of asthma symptoms and exacerbations during childhood.

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MP9: SINO-NASAL 5 QUESTIONNAIRE PREDICTS POOR ASTHMA CONTROL IN CHILDREN WITH PERSISTENT ASTHMA

Journal of Investigative Medicine ◽

10.1136/jim-2016-000080.21 ◽

2016 ◽

Vol 64 (3) ◽

pp. 808.1-808

Author(s):

G Phull ◽

D Prue ◽

C Martinez ◽

K Scheffey ◽

D Pillai

Keyword(s):

Asthma Control ◽

Persistent Asthma ◽

Upper Airway ◽

Asthma Severity ◽

Life Questionnaire ◽

Night Time ◽

Time Activity ◽

Asthmatic Children ◽

Airway Symptoms ◽

The Impact

Purpose of StudyUp to 80% of asthmatic children may experience upper airway symptoms, including rhinitis, often perceived as coming from lower airways. Asthma diagnosis, classification and assessment of control are defined by the National Asthma Education Prevention Program (NAEPP) 2007 guidelines, but may understate the impact of the upper airway. We explored associations between Sino-Nasal 5 (SN-5) quality of life questionnaire, validated in radiographic confirmed sinus disease, and NAEPP asthma impairment in children. We hypothesize that children with NAEPP defined uncontrolled asthma will have abnormal SN-5 scores.Methods UsedWe performed a retrospective chart review of children (1–21 yr) referred to a pediatric pulmonary clinic for persistent asthma. Data collected include age, gender, BMI%, NAEPP asthma severity, SN-5, asthma control (TRACK children <5 y, ACT children ≥5 y) and pulmonary function testing (PFT). The primary analysis was to identify associations between SN-5 scores and levels of NAEPP guideline impairment: daytime symptoms, night time awakenings, activity interference and PFTs. Significant SN-5 scoring was defined as ≥3.5 based on prior studies. PFT was performed in children ≥5 y. Statistical analysis with SPSS 22.Summary of Results76 children were evaluated; 38% female, mean age 6.9 y and mean BMI% 69%. Significant SN-5 score (≥3.5 vs. <3.5) was associated with decreased control of daytime symptoms (OR 0.16 [95% CI:0.06–0.44]), night time awakenings (OR 0.09 [0.03–0.29]), activity interference (OR 0.2 [0.06–0.68]) and asthma control (OR 0.32 [0.12–0.85]). Those with SN-5 ≥3.5 had poor asthma control based on TRACK (p<0.002) and ACT (p<0.001). Age, gender, BMI%, asthma severity and PFTs were not associated with SN-5.ConclusionsIn persistent asthmatic children, NAEPP defined daytime, night time, activity related impairment and poor asthma control were associated with a significant SN-5 score; PFTs and NAEPP asthma severity were not. This suggests that upper airways may play a larger role in lower airway associated symptoms, and that SN-5 may be beneficial in assessing asthma symptoms. Recognizing and treating upper airway symptoms, an understated area in asthma guidelines, might improve overall asthma control. A prospective analysis in a larger cohort is recommended to evaluate these findings.

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The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People

Depression Research and Treatment ◽

10.1155/2013/926562 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8

Author(s):

Tero Raiskila ◽

Sanna Blanco Sequeiros ◽

Jorma Kiuttu ◽

Marja-Liisa Kauhanen ◽

Kristian Läksy ◽

...

Keyword(s):

Controlled Trial ◽

Intervention Group ◽

First Episode ◽

Control Group ◽

Treatment As Usual ◽

Intervention Treatment ◽

Working Age ◽

Rehabilitative Intervention ◽

One Year ◽

The Impact

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people.Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment.Subjects. The subjects came from occupational health care units.Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N=283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N=134) and the control group was treated in the conventional way (N=100). They were followed for one year.Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P=0.013).Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.

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Abstract 3544: One year follow-up after acute Coronary Artery Disease (CAD) - Immediate hospital discharge vs. cardiac rehabilitation

Circulation ◽

10.1161/circ.116.suppl_16.ii_802-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Bernhard Schwaab ◽

Annika Waldmann ◽

Alexander Katalinic ◽

Britta Poppe ◽

Abdolhamid Sheikhzadeh ◽

...

Keyword(s):

Risk Reduction ◽

Absolute Risk ◽

Controlled Trial ◽

Absolute Risk Reduction ◽

Number Needed To Treat ◽

Preventive Medication ◽

All Cause Mortality ◽

Artery Disease ◽

One Year ◽

The Impact

Background: The evidence of cardiac Rehab is not fully settled as meta-analysis mostly included studies without acute revascularisation and modern preventive medication. Method: In a multicentre randomised controlled trial, 1.474 patients (pts.) with acute CAD were included to investigate the impact of telemedicine on chronic CAD: 679 pts. were included immediately at discharge from the hospital (Hosp), 795 pts. after three week in-patient Rehab. All pts. had acute coronary angiography and were followed for one year. As Hosp pts. were included 11,3 ± 3 days (median 11) earlier than Rehab pts., events in the Hosp group were counted from day 12. Results: Rehab pts. were older (64 ±10 vs. 62 ±10 years; p<.001), had more congestive heart failure (64 vs. 40%, p<.001), renal insufficiency (10 vs. 7%, p=.036), hypercholesterolemia (79 vs. 74%, p=.023), and carotid stenosis (8 vs. 4%, p=.004). Telemedicine device prescription, gender, atrial fibrillation, peripheral artery disease, diabetes, hypertension, education and social status were similar in groups. After one year, Rehab pts. had more β-blockers (88 vs. 75%, p<.001), ACE-inhibitors (81 vs. 70%, p<.001), lower LDL-C (102 ±35 vs. 121 ±47 mg/dl, p<.001) and a higher proportion of non-smokers (62 vs. 56%, p=.024). There was no difference in platelet inhibition, anticoagulation and statin therapy (81 vs. 79%). The primary combined endpoint of all-cause mortality, acute myocardial infarction (AMI), coronary revascularisation and hospitalisation occurred in 32.6% of Rehab pts. and in 38.7% of Hosp pts. (p=.014; absolute risk reduction (ARR) 0.0615, relative risk reduction (RRR) 16%, number needed to treat (NNT) 17). AMI (1.8 vs. 3.8%, p=.015; ARR 0.0207, RRR 54%, NNT 49) was reduced. Revascularisation (4.2 vs. 5.4%), hospitalisation (33.6 vs. 38.0%) and all-cause mortality (2.1 vs. 2.4%) were similar between groups. After multivariate analysis, the primary endpoint was still significant: OR 0.716 (95% CI 0.575–0.892; p=0.003) giving a RRR of 28% in favour of Rehab therapy. Conclusion: Although Rehab pts. were sicker at entry, cardiac Rehab substantially reduced relevant clinical endpoints within one year. With a very low NNT, Rehab is highly effective and should be advised to all suitable patients with acute CAD.

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