Adjunctive topical oxygen therapy offers promise in accelerating diabetic foot ulcer healing. We hypothesize that topical warm oxygen delivered at a controlled temperature (42 °C) through a ...proprietary device (KADAM™) will improve ulcer healing and be well-tolerated among patients with type 2 diabetes mellitus and with foot ulcers of Wagner-Meggitt grades 2 and 3. This trial employed a randomized controlled, open label design, with the outcome assessor blinded to allocation. We randomized 20 patients in a 1:1 allocation ratio, to intervention and control (standard of care) arms. The intervention arm received in-hospital topical warm oxygen at 42 °C for 90 min/session. This was repeated on alternate days for 6 weeks (18 sessions). Patients in the control group got standard care, and all received standard wound care. The primary outcome was a change in the ulcer area from baseline visit to follow-up at 6 weeks, day 5. There was a significant reduction in the area of the ulcer in the intervention group between baseline and week 6, day 5 log area intervention group baseline vs week 6 day 5, 2.72 (0.57) vs 1.54 (0.95), change = − 1.18 (− 0.58, − 1.78),
p
= 0.019. Between-group ulcer area at week 6, day 5, was also significantly different intervention vs control (log area), 1.54 (0.95) vs 2.94 (1.05),
p
= 0.005, with the difference favoring the intervention group. There were no adverse reactions in the intervention arm. Adjunctive topical warm oxygen delivered at 42 °C and normal pressure can potentially improve diabetic foot ulcer healing and is well-tolerated.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We developed a three-pronged complex intervention to improve selfcare and deliver whole person care for patients with heart failure, underpinned by the ‘extant cycle’ theory – a theory based on our ...formative work.
This is a 3 centre, 2-arm, 1:1, open, adaptive stratified, randomized controlled trial. We included patients aged ≥ 18 years with heart failure, taking any of the key guideline directed medical treatments, with a history of or currently on a high ceiling diuretic. We excluded end stage renal disease, clinically diagnosed severe mental illness or cognitive dysfunction and having no caregivers. Interventions included, (i) trained hospital based lay health worker mediated assessment of patients' current selfcare behaviour, documenting barriers and facilitators and implementing a plan to ‘transition’ the patient toward optimal selfcare. (ii) m-health mediated remote monitoring and (iii) dose optimization through a ‘physician supervisor’.
We recruited 301 patients between Jan 2021 and Jan 2022. Mean age was 59.8 (±11.7) years, with 195 (64.8 %) from rural or semi-urban areas and 67.1 % having intermediate to low health literacy. 190 (63.1 %) had an underlying ischemic cardiomyopathy. In the intervention arm, 142 (94.1 %) had a Selfcare in Heart Failure Index (SCHFI) score of ≤70, with significant barriers being ‘lack of knowledge’ 105 (34.5 %) and ‘behavioural passivity’ 23 (7.5 %).
This is the first South Asian trial evaluating a complex intervention underpinned by behaviour change theory for whole person heart failure care. These learnings can be applied to heart failure patient care in other resource constrained health systems.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
: Adherence to a complex, yet effective medication regimen improves clinical outcomes in patients with chronic heart failure (CHF). However, patient adherence to an agreed upon plan for ...medication-taking is sub-optimal and continues to hover at 50% in developed countries. Studies to improve medication-taking have focused on interventions to improve adherence to guideline-directed medication therapy, yet few of these studies have integrated patients' perceptions of what constitutes effective strategies for improved medication-taking and self-care in everyday life. The purpose of this formative study was to explore patient perceived facilitators of selfcare and medication-taking in South Asian CHF patients.
: We conducted in-depth interviews of patients with long standing heart failure admitted to the cardiology and internal medicine wards of a South Indian tertiary care hospital. We purposively sampled using the following criteria: sex, socio-economic status, health literacy and patient reported medication adherence in the month prior to hospitalization. We employed inductive coding to identify facilitators. At the end of 15 interviews (eight patients and seven caregivers; seven patient-caregiver dyads), we arrived at theoretical saturation for facilitators.
: Facilitators could be classified into intrinsic (patient traits - situational awareness, self-efficacy, gratitude, resilience, spiritual invocation and support seeking behavior) and extrinsic (shaped by the environment - financial security and caregiver support, company of children, ease of healthcare access, trust in provider/hospital, supportive environment and recognizing the importance of knowledge).
We identified and classified a set of key patient and caregiver reported self-care facilitators among Indian CHF patients. The learnings from this study will be incorporated into an intervention package to improve patient engagement, overall self-care and patient-caregiver-provider dynamics.
Aim
To determine the frequency of occurrence, risk factors, clinical spectrum and drugs associated with adverse drug reactions (ADRs) occurring in the coronary care unit (CCU) of a tertiary care ...hospital.
Methods
This was a retrospective cohort study based on evaluation of the medical records of consecutive patients admitted to the CCU between January 2008 and December 2008. Each prescription was monitored for ADRs, and each ADR was assessed for causality, severity, predictability and preventability by two physicians using relevant scales. The chi-square test and independent
t
test were used to compare the ADR and non-ADR groups. Multiple binary logistic regression was used to identify risk factors for developing ADRs in the CCU.
Results
Of 595 patients, 152 (25.5%) developed ADRs, of which 45% were potentially preventable. Severe ADRs constituted 28.6% of the total ADRs. Patients who developed an ADR had a longer duration of stay in the hospital (2.8 extra days) (
p
< 0.05). Hypokalemia/hyperkalemia (22%), bleeding (11%) and cardiac arrhythmias (11%) were the commonest ADRs. The highest rates of ADRs were seen with streptokinase (59.4%). The predictors for developing an ADR in the CCU included renal dysfunction odds ratio (OR) 1.66, 95% confidence interval (CI) 1.007–2.72, arrhythmias (OR 1.74, 95% CI 1.052–2.87) and polypharmacy with more than ten drugs (OR 11.3, 95% CI 1.45–87.44).
Conclusion
A high frequency of ADR occurrence was identified, with many of the ADRs being potentially preventable. Patients with renal dysfunction or cardiac arrhythmias and those receiving polypharmacy were at an increased risk for developing an ADR in the CCU.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Optical and near-infrared spectroscopic observations of the fast nova V1494 Aquilae 1999 no. 2 covering various phases — early decline, transition and nebular — during the first 18 months of its ...post-outburst evolution are presented in this paper. During this period, the nova evolved in the PfePofeCo spectral sequence. The transition from an optically thick wind to a polar blob—equatorial ring geometry is seen in the evolution of the spectral line profiles. There is evidence of density and temperature stratification in the ejecta. Physical conditions in the ejecta have been estimated based on our observations.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Effects of a quick-release form of bromocriptine (Ergoset) on fasting and postprandial plasma glucose, insulin, lipid, and
lipoprotein concentrations in obese nondiabetic hyperinsulinemic women.
V ...Kamath ,
C N Jones ,
J C Yip ,
B B Varasteh ,
A H Cincotta ,
G M Reaven and
Y D Chen
Department of Medicine, Stanford University, School of Medicine, CA 94305-5013, USA.
Abstract
OBJECTIVE: To assess the effect on various aspects of carbohydrate and lipid metabolism of administering a quick-release formulation
of bromocriptine (Ergoset) to obese, nondiabetic, hyperinsulinemic women. RESEARCH DESIGN AND METHODS: Hourly concentrations
of prolactin, glucose, insulin, free fatty acid (FFA), and triglyceride were measured for 24 h before and after approximately
8 weeks of treatment with Ergoset. In addition, fasting lipid and lipoprotein concentrations and the steady-state plasma glucose
(SSPG) concentration in response to a continuous infusion of somatostatin, insulin, and glucose were determined before and
after Ergoset administration. RESULTS: Circulating prolactin concentrations were dramatically decreased (P < 0.001) following
treatment, associated with a significant fall (P < 0.05) in 24-h-long plasma glucose, FFA, and triglyceride concentrations.
Neither circulating plasma insulin concentrations nor the ability of insulin to mediate glucose disposal changed with treatment.
Finally, fasting total cholesterol fell (P < 0.05) and the ratio of total to HDL cholesterol decreased (P = 0.06) in association
with Ergoset treatment. CONCLUSIONS: The fact that significant metabolic improvement was seen in the obese nondiabetic hyperinsulinemic
women studied suggests that Ergoset could be of therapeutic benefit in clinical conditions of hyperglycemia and/or dyslipidemia.
Abstract Atrial fibrillation (AF) is common, increasing as the population ages, and a major cause of embolic stroke. While oral anticoagulation (OAC) is highly effective at preventing stroke in ...patients with AF, it continues to be underused in eligible patients worldwide. The objective of this prospective, cluster randomized controlled trial (IMPACT-AF; ClinicalTrials.gov #NCT02082548) is to determine whether a comprehensive customized intervention will increase the rate and persistence of use of OAC in patients with AF. IMPACT-AF will be conducted in approximately 50 centers in 5 low- to middle-income countries. Before randomization, sites within countries will be paired to match in size, practice type and baseline rate of OAC use. Site pairs will be randomized to intervention versus control. In total, 40 to 70 patients with AF and at least 2 CHA2 DS2 -VASc risk factors will be enrolled at each site using a consecutive enrollment strategy, with the goal of capturing actual practice patterns. We aim for patients with a new diagnosis of AF to comprise at least 30% of the study cohort. Assuming an average baseline OAC use of 60% and a post-intervention use of 70% with a post-control rate of 60%, there will be roughly 94-98% power with 25 clusters per group (intracluster correlation coefficient of 0.02). While this trial focuses on improving treatment use and reducing preventable strokes, we aim to better understand the reasons for OAC underuse. This will improve the intervention with the goal of creating educational recommendations to improve care for patients with AF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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