scholarly journals Infectious Disease Team Review Using Antibiotic Switch and Discharge Criteria Shortens the Duration of Intravenous Antibiotic: A Single-Center Cluster-Randomized Controlled Trial in Thailand

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Thanyarak Wongkamhla ◽  
Buddharat Khan-asa ◽  
Sasima Tongsai ◽  
Nasikarn Angkasekwinai
Keyword(s):  
Infectious Disease ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Defined Daily Dose ◽  
Randomized Controlled ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Cluster Randomized ◽  
Discharge Criteria

Abstract Background Strategies have been recommended to optimize early antibiotic (ATB) switching from intravenous (IV) to oral ATB. This study aimed to determine whether infectious disease (ID) team review using ATB switch and discharge criteria would shorten the duration of IV ATB and length of hospital stay (LOS). Methods This cluster-randomized controlled trial was conducted in 8 general medical wards as cluster units at Siriraj Hospital during January–October 2019. The ID team review with checklist criteria was performed on the third, fifth, and seventh day of IV-ATB treatment to determine (1) the suitability of switching to oral ATB or outpatient parenteral ATB therapy and (2) early discharge for patients receiving IV-ATB versus control. The primary outcomes were LOS and the duration or days of therapy (DOT) or defined daily dose (DDD) of IV-ATB therapy. Results Four wards each were randomly assigned to the intervention and control groups (46 patients/cluster, 184 patients/arm). No significant difference was observed between intervention and controls for median duration of IV-ATB therapy (7 vs 7 days) and LOS (9 vs 10 days). A significantly shorter duration of IV ATB was observed in patients without sepsis in the intervention group when measured by DOT (7 vs 8 days, P = .027) and DDD (7 vs 9, P = .017) in post hoc analysis. Conclusions Infectious disease team review using checklist criteria did not result in a shorter duration of IV-ATB and LOS in overall patients. Further study is needed to determine whether faster culture turnaround time or advanced testing will reduce the duration of IV-ATB therapy.

A noninferiority cluster-randomized controlled trial on antibiotic postprescription review and authorization by trained general pharmacists and infectious disease clinical fellows

2018 ◽  
Vol 39 (10) ◽  
pp. 1154-1162 ◽  
Author(s):  
Pinyo Rattanaumpawan ◽  
Prasit Upapan ◽  
Visanu Thamlikitkul
Keyword(s):  
Infectious Disease ◽  
Randomized Controlled Trial ◽  
Clinical Response ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Favorable Clinical Response ◽  
The Difference ◽  
Cluster Randomized

AbstractObjectiveWe compared the effectiveness of antibiotic postprescription review and authorization (PPRA) determined by infectious disease (ID) clinical fellows with that of trained general pharmacists.MethodsWe conducted a noninferiority cluster-randomized controlled trial in 6 general medical wards at Siriraj Hospital in Bangkok, Thailand. Three wards were randomly assigned to the intervention (ie, the pharmacist PPRA group), and another 3 wards were assigned to the control (ie, the fellow PPRA group). We enrolled all patients in the study wards who received 1 or more doses of the targeted antibiotics: piperacillin/tazobactam, imipenem/cilastatin, and meropenem. The noninferiority margin was 10% for the favorable clinical response and 1.5 defined daily doses (DDDs) for the targeted antibiotics.ResultsWe enrolled 303 patients in the pharmacist PPRA group and 307 patients in the ID fellow PPRA group. The baseline and clinical characteristics were similar in the 2 groups. The difference in the favorable response of patients who received the targeted antibiotics (ie, the pharmacist PPRA group minus the fellow PPRA group) was 5.15% (95% confidence interval [CI], –2.69% to 12.98%); the difference in the DDD of targeted antibiotic use (ie, the pharmacist PPRA group minus the fellow PPRA group) was 0.62 (95% CI, –1.57 to 2.82). We observed no significant difference in the DDD of overall antibiotics, 28-day mortality, 28-day ID-related mortality, favorable microbiological outcome, or antibiotic-associated complications.ConclusionsWe confirmed the noninferiority of pharmacist PPRA in terms of favorable clinical response; however, noninferiority in targeted antibiotic consumption could not be established. Therefore, using trained general pharmacists rather than ID clinical fellows could be an alternative in a resource-limited setting.Clinical trials registration: clinicaltrials.gov identifier: NCT 01797133

scholarly journals Effectiveness of unconditional cash transfers combined with lipid-based nutrient supplement and/or behavior change communication to prevent stunting among children in Pakistan: a cluster randomized controlled trial

2021 ◽  
Author(s):  
Sajid Bashir Soofi ◽  
Shabina Ariff ◽  
Gul Nawaz Khan ◽  
Atif Habib ◽  
Sumra Kureishy ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Behavior Change ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Behavior Change Communication ◽  
Randomized Controlled ◽  
Change Communication ◽  
Nutrient Supplement ◽  
Significant Difference ◽  
Cluster Randomized

Abstract Background In Pakistan, the prevalence of stunting among children under-five years has remained above WHO critical thresholds (≥30%) over the last two decades. Objective We hypothesized that an unconditional cash transfer (UCT) combined with lipid-based nutrient supplement (LNS) and/or social and behavior change communication (SBCC) will prevent stunting among children 6-23 months of age. Design This was a four-arm, community-based cluster randomized controlled trial conducted in the district of Rahim Yar Khan, Pakistan. A total of 1729 children (UCT n = 434); (UCT+SBCC n = 433); (UCT+LNS n = 430) and (UCT+LNS+SBCC n = 432) were enrolled at 6 months of age and measured monthly for 18 months until the age of 24 months. Results At 24 months of age, children who received UCT+LNS (rate ratio [RR], 0.85 [95% CI 0.74, 0.97]; P = 0.015); and UCT+LNS+SBCC (RR, 0.86 [95% CI 0.77, 0.96]; P = 0.007) had significantly lower risk of being stunted as compared to the UCT arm. No significant difference was noted among children who received UCT+SBCC (RR, 1.03 [95% CI 0.91, 1.16]; P = 0.675) in the risk of being stunted as compared to the UCT arm. The pooled prevalence of stunting among children 6-23 months was 41.7%, 44.8%, 38.5% and 39.3% in UCT, UCT+SBCC, UCT+LNS and UCT+LNS+SBCC, respectively. In pairwise comparisons, a significant impact on stunting among children in UCT+LNS (P = 0.029) and UCT+LNS+SBCC (P = <0.001) was noted as compared to UCT arm. Conclusions UCT combined with LNS and UCT+LNS+SBCC were effective in reducing the prevalence of stunting among children aged 6-23 months in marginalized populations. UCT+SBCC was not effective in reducing the child stunting prevalence. Clinical trial registration number: ClinicalTrials.gov NCT03299218

scholarly journals A Cluster Randomized Controlled Trial Evaluating the Impact of Tailored Feedback on the Purchase of Healthier Foods from Primary School Online Canteens

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2405
Author(s):  
Fiona Stacey ◽  
Tessa Delaney ◽  
Kylie Ball ◽  
Rachel Zoetemeyer ◽  
Christophe Lecathelinais ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Primary Schools ◽  
Controlled Trial ◽  
Saturated Fat ◽  
Sodium Content ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Cluster Randomized ◽  
The Impact

Few online food ordering systems provide tailored dietary feedback to consumers, despite suggested benefits. The study aim was to determine the effect of providing tailored feedback on the healthiness of students’ lunch orders from a school canteen online ordering system. A cluster randomized controlled trial with ten government primary schools in New South Wales, Australia was conducted. Consenting schools that used an online canteen provider (‘Flexischools’) were randomized to either: a graph and prompt showing the proportion of ‘everyday’ foods selected or a standard online ordering system. Students with an online lunch order during baseline data collection were included (n = 2200 students; n = 7604 orders). Primary outcomes were the proportion of foods classified as ‘everyday’ or ‘caution’. Secondary outcomes included: mean energy, saturated fat, sugar, and sodium content. There was no difference over time between groups on the proportion of ‘everyday’ (OR 0.99; p = 0.88) or ‘caution’ items purchased (OR 1.17; p = 0.45). There was a significant difference between groups for average energy content (mean difference 51 kJ; p−0.02), with both groups decreasing. There was no difference in the saturated fat, sugar, or sodium content. Tailored feedback did not impact the proportion of ‘everyday’ or ‘caution’ foods or the nutritional quality of online canteen orders. Future research should explore whether additional strategies and specific feedback formats can promote healthy purchasing decisions.

scholarly journals Improved recording of work relatedness during patient consultations in occupational primary health care: A cluster randomized controlled trial using routine and register data

2019 ◽  
Author(s):  
Salla Atkins ◽  
Tiia Reho ◽  
Nina Talola ◽  
Markku Sumanen ◽  
Mervi Viljamaa ◽  
...  
Keyword(s):  
Health Care ◽  
Randomized Controlled Trial ◽  
Occupational Health ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Electronic Reminder ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Cluster Randomized

Abstract Background Prolonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers, through preventing illnesses that cause work disability and early pensions. However, this requires close follow-up and recording of patient health status during consultations, as well as continuity of care. We aimed to determine whether a combined educational and electronic reminder system could improve the recording and follow-up of patient primary care visits in occupational health care, and through this, to impact on sickness absence rates. Methods This study is a pragmatic cluster randomized controlled trial using medical record data. Data were extracted from routine patient registers collected by Pihlajalinna Työterveys from 2015 to 2017. Data were cleaned and analysed intention-to-treat using ANCOVA. Results There was no significant difference between intervention and control sites in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians’ practice following the educational component of the intervention. Conclusion Education with an electronic reminder can change physicians’ practice, but longer term follow-up is needed to determine whether this impacts on patients’ sickness absences.

scholarly journals The Effect of Oral Health Promotion Program on Early Dental Decay in Students: a Cluster Randomized Controlled Trial

2019 ◽  
Vol 8 (2) ◽  
pp. 105-110 ◽  
Author(s):  
Vahid Naseri Salahshour ◽  
Hamid Abredari ◽  
Mahbobeh Sajadi ◽  
Masoumeh Sabzaligol ◽  
Mahmood Karimy
Keyword(s):  
Randomized Controlled Trial ◽  
Elementary Students ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Control Group ◽  
Oral Health Promotion ◽  
Dental Decay ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Cluster Randomized

Introduction: The use of different models play a significant role in health education and its promotion. Therefore, the present study aims to investigate the effect of the Theory of Planned Behavior (TPB) on early dental decay in elementary students. Methods: This study was a single-blinded, cluster randomized controlled trial, in which 470 elementary students in the fourth, fifth and sixth grades in Saveh, Iran were participated. A demographic questionnaire and a 5-item questionnaire consisting of questions on awareness, attitude, practice, tooth brushing, diet and referring to dentist, were used to data collection. The samples of the intervention (n=234) and control (n=236) groups filled out the questionnaires before intervention (pre-test), immediately after intervention and one month after intervention. The educational intervention based on the TPB was held in three 45-minute sessions. Finally, the data were analyzed, using the SPSS version 13. For analyzing, the Independent t-test, Chi-square, and repeated measures ANOVA were used. Results: This study showed that there is a significant difference in the mean scores obtained from knowledge, attitude, subjective norm, perceived behavioral control, behavioral intention and behavior among students in the experimental group (immediately after and one month after the intervention) and students in the control group. Conclusion: The results of this study showed that using of TPB, as a framework for providing behavior-led training, can be effective in promoting oral and dental health of students. Nurses as an important member of the treatment team can use the results of this study in school health programs.

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