Study protocol of the GRoningen early-PD Ambroxol treatment (GREAT) trial: a randomized, double-blind, placebo-controlled, single center trial with ambroxol in Parkinson patients with a GBA mutation

BACKGROUND

To date, no disease modifying therapies are available for Parkinson's disease (PD). Since PD is the second most prevalent neurodegenerative disorder, there is a high demand for such therapies. Both environmental and genetic risk factors play an important role in the etiology and progression of PD. The most common genetic risk factor for PD is a mutation in the GBA1(GBA)-gene, encoding the lysosomal enzyme glucocerebrosidase (GCase). The mucolytic ambroxol is a repurposed drug, which has shown the property to upregulate GCase activity in-vitro and in-vivo. Ambroxol therefore has the potency to become a disease modifying therapy in PD, which was the reason to design this randomized controlled trial with ambroxol in PD patients.

METHODS

This trial is a single-center, double-blind, randomized, placebo-controlled study, including 80 PD patients with a GBA mutation, receiving either ambroxol 1800 mg/day or placebo for 48 weeks. The primary outcome measure is the Unified Parkinson's Disease Rating Scale motor subscore (part III) of the Movement Disorder Society (MDS-UPDRSIII) in the practically defined off-state at 60 weeks (after a 12-week washout period). Secondary outcomes include a 3,4-dihydroxy-6-18F-fluoro-I-phenylalanine ([18F]FDOPA) PET-scan of the brain, Magnetic Resonance Imaging (with resting state f-MRI and Diffusion Tensor Imaging), GCase activity, both intra- and extracellularly, sphingolipid profiles in plasma, Montreal Cognitive Assessment (MoCA), quality of life (QoL) measured by the Parkinson's Disease Questionnaire (PDQ-39) and the Non-Motor Symptom Scale (NMSS) questionnaire.

DISCUSSION

Ambroxol up to 1200 mg/day has shown effects on human cerebrospinal fluid endpoints, which supports at least passage of the blood-brain-barrier. The dose titration in this trial up to 1800 mg/day will reveal if this dose level is safe and also effective in modifying the course of the disease.

TRIAL REGISTRATION

NCT05830396. Registration date: March 20, 2023.

Effectiveness of an intervention program on physical activity in children with narcolepsy type 1

OBJECTIVES

Physical activity (PA) is recommended as part of the management of narcolepsy type 1 (NT1). This study aimed at 1) characterizing PA in children and adolescents treated for NT1 using objective and subjective measurements, 2) evaluating how PA is associated with NT1 symptoms and comorbidities, and 3) evaluating the effects of an Adapted Physical Activity (APA) program on PA and clinical characteristics.

PATIENTS/METHODS

Patients with NT1 from the National Reference Center of Narcolepsy (Lyon, France) were consecutively included in an APA intervention protocol. Narcolepsy symptoms and comorbidities were collected using standardized questionnaires and sustained attention was evaluated using the Bron-Lyon Attention Stability Test before and after the four-week APA intervention. PA was measured objectively using actigraphy throughout the study.

RESULTS

Twenty-seven NT1 patients were included (median age 14.7 years [8.3-18.4], cataplexy 88.9%, obesity 37.0%). At baseline, 52.4% of the patients had satisfactory PA levels according to international recommendations. Patients with leisure-time PA (LTPA) showed higher quality of life than patients without. 45% of the patients increased PA during the intervention compared to baseline. These responsive patients had more depressive feelings and tended to have lower objective PA than non-responsive patients at baseline. No significant correlation was found between PA levels before and during the intervention and other clinical data.

CONCLUSIONS

Most children with NT1 showed satisfying PA levels despite their daytime sleepiness. LTPA engagement was associated with higher quality of life. An APA intervention could be effective in children with narcolepsy, especially for those with depressive feelings.

Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a prospective interventional study

BACKGROUND

Orthogeriatric patients have an increased risk for complications due to underlying comorbidities, chronic drug therapy and frequent treatment changes during hospitalization. The clinical pharmacist (CP) plays a key role in transmural communication concerning polypharmacy to improve continuity of care by the general practitioner (GP) after discharge. In this study, a pharmacist-led transmural care program, tailored to orthogeriatric patients, was evaluated to reduce drug related problems (DRPs) after discharge.

METHODS

An interventional study was performed (pre-period: 1/10/2021-31/12/2021; post-period: 1/01/2022-31/03/2022). Patients (≥ 65 years) from the orthopedic department were included. The pre-group received usual care, the post-group received the pharmacist-led transmural care program. The DRP reduction rate one month after discharge was calculated. Associated factors for the DRP reduction rate were determined in a multiple linear regression analysis. The GP acceptance rate was determined for the proposed interventions, as well as their clinical impact using the Clinical, Economic and Organizational (CLEO) tool. Readmissions one month after discharge were evaluated.

RESULTS

Overall, 127 patients were included (control n = 61, intervention n = 66). The DRP reduction rate was statistically significantly higher in the intervention group compared to the control group (p < 0.001). The pharmacist's intervention was associated with an increased DRP reduction rate (+ 1.750, 95% confidence interval 1.222-2.278). In total, 141 interventions were suggested by the CP, of which 71% were accepted one month after discharge. In both periods, four patients were readmitted one month after discharge. 58% of the interventions had a clinical impact (≥ 2 C level using the CLEO-tool) according to the geriatrician and for the CP it was 45%, indicating that they had the potential to avoid patient harm.

CONCLUSIONS

The pharmacist-led transmural care program significantly reduced DRPs in geriatric patients from the orthopedic department one month after discharge. The transmural communication with GPs resulted in a high acceptance rate of the proposed interventions.

Effect of Filgotinib on Body Mass Index (BMI) and Effect of Baseline BMI on the Efficacy and Safety of Filgotinib in Rheumatoid Arthritis

INTRODUCTION

This post hoc analysis of the phase 3 rheumatoid arthritis (RA) filgotinib clinical trial program assessed the effect of filgotinib on body mass index (BMI) in patients with RA and the impact of BMI on the efficacy and safety of filgotinib.

METHODS

FINCH 1-3 were randomized, double-blind, active- or placebo-controlled phase 3 trials of filgotinib 100 and 200 mg in patients with RA (N = 3452). BMI assessments included the mean change from baseline in BMI and the proportion of patients whose BMI increased by incremental thresholds. Efficacy measures included American College of Rheumatology (ACR) 20/50/70 response and low disease activity/remission according to Disease Activity Score 28 using C-reactive protein. The exposure-adjusted incident rate (EAIR) of adverse events (AEs) was assessed by baseline BMI, using integrated data from the FINCH 1-4 and the phase 2 DARWIN 1-3 studies (total filgotinib exposure = 8085 patient-years).

RESULTS

Mean change from baseline in BMI over time was similar across treatment arms. In most patients, BMI increased by ≤ 1 or 2 kg/m2 at both weeks 12 and 24, regardless of treatment group or baseline BMI; few patients had increases of ≥ 4 kg/m2. For most efficacy measures, filgotinib 200 mg was more efficacious than filgotinib 100 mg or active comparators or placebo across BMI subgroups. For the higher filgotinib dose, the EAIR of serious treatment-emergent AEs, venous thrombotic and embolic events, and major adverse cardiovascular events increased with increasing BMI.

CONCLUSIONS

Filgotinib did not lead to substantial changes in BMI, and BMI did not appear to affect the efficacy of filgotinib.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers: NCT02889796, NCT02873936, NCT02886728, NCT03025308, NCT01888874, NCT01894516, NCT02065700.

Effectiveness of Internet-based health management in patients with dyslipidemia: A four-year longitudinal study

BACKGROUND AND AIMS

Dyslipidemia is an important risk factor for coronary artery disease and stroke, and it has emerged as a major public health issue worldwide. Internet-based health management and intervention may offer a new approach to health management. This study was conducted to provide health guidance and education to people with dyslipidemia using an Internet health management platform and to assess the effectiveness of Internet health management and intervention in improving health-related behaviors and controlling blood lipids.

METHODS

Starting in 2013 (Baseline, N = 56,542), a Western longitudinal study in China was performed, and all interventional objects were provided with Internet health management. Health checkups were conducted annually, and questionnaires were administered every two years to analyze changes in health behaviors two years (2015) and four years (2017) following the intervention. In addition, factors affecting behavioral changes and lipid control were analyzed in the dyslipidemic population to understand the effectiveness and influencing factors of Internet health management on lipid control.

RESULTS

By guiding interventional objects through the Internet health management platform, the awareness rate of dyslipidemia increased from 19.1% in 2013 to 34.4% in 2017; and the control rate of dyslipidemia increased from 9.1% at baseline to 18.5%. Certain health-related behaviors that are beneficial to health (tobacco use, physical activity, and partial dietary) were gradually improved over the intervention time. For patients with dyslipidemia, triglyceride decreased from 2.90 mmol/L (2013) to 2.77 mmol/L (2017) as the years went by. Analysis of factors affecting lipid control showed that non-compliance with health instructions affected lipid control; in addition to these, being female (0.722, 95% CI: 0.546,0.954) was found to be a protective factor for effective lipid control.

CONCLUSIONS

The basic Internet-based health management platform in this study appears to be moderately successful and is a valuable and feasible application. Tobacco, dietary, and physical activity interventions provided significant protection against dyslipidemia in patients.

Correlation Between Lactic Acid Bacteria Beverage Intake and Stress Resilience

We investigated the effect of lactic acid bacteria-containing beverage intake on the level of resilience against stress in male university students. Forty male university students were recruited into the study and randomly assigned into two groups. They were instructed to consume lactic acid bacteria-containing beverage or water twice a day for 28 days. The level of stress resilience, stress reaction, and anxiety were evaluated by a series of questionnaires conducted at three time points (T1: day 0, T2: day 14, and T3: day 28). The stress response was also assessed by measuring their salivary amylase levels. The variance analysis of each group showed a significant increase in stress resilience at T3 compared with T1 in the group of participants who consumed the lactic acid bacteria-containing beverage. Our results suggest that lactic acid bacteria-containing beverage intake could affect resilience against stress positively.

Dietary guidelines training may improve health promotion practice: Results of a controlled trial in Brazil

BACKGROUND

The double burden of malnutrition points to an urgent need to develop strategies to promote healthy diets. Health professionals are key elements for health promotion and must be prepared to deal with these issues in health services.

AIM

This study aimed to evaluate the impact of an educational intervention based on Brazilian Dietary Guidelines in the practice of multidisciplinary teams working in primary health care.

METHODS

A controlled trial comprising pre- and post-tests was conducted with four multidisciplinary healthcare teams. The intervention group received 16 hours of training on the Brazilian Dietary Guidelines. The professionals' practices were evaluated by direct observation, before and after the intervention, for two months at each timepoint. Data on dietary counselling were collected using a previously validated scale. The Kruskal-Wallis test was used for intragroup comparison at T0 versus T1, and the intergroup effects of the intervention were estimated by generalized linear regression analysis with a 95% confidence interval.

RESULTS

The regression with the interaction term between the intervention group and time showed a positive effect of the educational intervention on professionals' practices in the intervention group in the crude and adjusted models (coefficient = 1.36 and p = 0.020). Brazilian Dietary Guidelines application significantly increased in non-nutritionist professionals' practices (p = 0.007) and in activities not related to nutrition (p = 0.028) in the intervention group over time (T1-T0). No significant differences were found in the control group.

CONCLUSION

The intervention proved to be effective in promoting changes in health professionals' practices, demonstrating the strength of the strategy for dissemination of nutrition guidelines in primary health care.

Introducing virtual reality therapy for inpatients with dementia admitted to an acute care hospital: learnings from a pilot to pave the way to a randomized controlled trial

Background

Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, particularly in acute care settings. As virtual reality (VR) technology becomes increasingly accessible and affordable, there is growing interest among clinicians to evaluate VR therapy in hospitalized patients, as an alternative to administering antipsychotics/sedatives or using physical restraints associated with negative side effects.

Objectives

Validate and refine the proposed research protocol for a randomized controlled trial (RCT) that evaluates the impact of VR therapy on managing BPSD in acute care hospitals. Special attention was given to ascertain the processes of introducing non-pharmacological interventions in acute care hospitals.

Methods

Ten patients 65 years or older (mean = 87) previously diagnosed with dementia, admitted to an acute care hospital, were recruited over 3-month period into a prospective longitudinal pilot study. The intervention consisted of viewing 20-min of immersive 360° VR using a head-mounted display. Baseline and outcomes data were collected from the hospital electronic medical records, pre/post mood-state questionnaires, Neuropsychiatric Inventory (NPI) score, and standardized qualitative observations. Comprehensive process data and workflow were documented, including timestamps for each study task and detailed notes on personnel requirements and challenges encountered.

Results

Of 516 patients admitted during the study, 67 met the inclusion/exclusion criteria. In total, 234 calls were initiated to substitute decision makers (SDM) of the 67 patients for the consenting process. Nearly half (45.6%) of SDMs declined participation, and 40% could not be reached in time before patients being discharged, resulting in 57 eligible patients not being enrolled. Ten consented participants were enrolled and completed the study. The initial VR session averaged 53.6 min, largely due to the administration of NPI (mean = 19.5 min). Only four participants were able to respond reliably to questions. Seven participants opted for additional VR therapy sessions; of those providing feedback regarding the VR content, they wanted more varied scenery (animals, fields of flowers, holiday themes). Few sessions (4/18) encountered technical difficulties.

Conclusion

The pilot was instrumental in identifying issues and providing recommendations for the RCT. Screening, inclusion criteria, consenting, data collection, and interaction with SDMs and hospital staff were all processes requiring changes and optimizations. Overall, patients with dementia appear to tolerate immersive VR, and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-020-00708-9.

Improving knowledge, self-efficacy and collective efficacy regarding the Brazilian dietary guidelines in primary health care professionals: a community controlled trial

Background

Capacity-building of health professionals regarding to nutrition is a strategy for qualifying public health work to promote healthy diets in primary health care (PHC) services.

Objective

To evaluate the effect of an intervention based on Brazilian Dietary Guidelines (BDG) on the knowledge, self-efficacy (SE) and collective efficacy (CE) of interprofessional teams working in PHC.

Methods

It refers to a pre-post intervention study involving 24 health professionals divided into a control group (CG) and intervention (IG). The IG received a 16-h educational workshop on the BDG, guided by a validated protocol. Knowledge, SE and CE for using the BDG were assessed via a self-administered scale, ranging from 0 to 16 and 0 to 36 points, respectively; the scale was previously validated, completed before and after 2 months of the intervention. The effects of the intervention were estimated by paired t-test for intragroup comparisons over time.

Results

The mean difference in the knowledge and SE scores of the IG pre- and post-intervention was 2.0 (CI 0.49–3.51) and 6.75 (CI 4.05–9.45) points, respectively. These results means the IG participants obtained 59 and 52.8% more points in knowledge and in SE in relation to CG, with significative difference (p = 0.007 and p <  0.00, respectively). There was no significant variation in the CE scores in both groups.

Conclusions

Considering the results presented and due to the originality of the study in question, the educational workshop was effective in increasing the knowledge and SE of professionals working in PHC in using the Dietary Guidelines in their work routines. These findings can assist other research in developing nutrition interventions with interprofessional teams.

Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?

Methodological quality (risk of bias) assessment is an important step before study initiation usage. Therefore, accurately judging study type is the first priority, and the choosing proper tool is also important. In this review, we introduced methodological quality assessment tools for randomized controlled trial (including individual and cluster), animal study, non-randomized interventional studies (including follow-up study, controlled before-and-after study, before-after/ pre-post study, uncontrolled longitudinal study, interrupted time series study), cohort study, case-control study, cross-sectional study (including analytical and descriptive), observational case series and case reports, comparative effectiveness research, diagnostic study, health economic evaluation, prediction study (including predictor finding study, prediction model impact study, prognostic prediction model study), qualitative study, outcome measurement instruments (including patient - reported outcome measure development, content validity, structural validity, internal consistency, cross-cultural validity/ measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, and responsiveness), systematic review and meta-analysis, and clinical practice guideline. The readers of our review can distinguish the types of medical studies and choose appropriate tools. In one word, comprehensively mastering relevant knowledge and implementing more practices are basic requirements for correctly assessing the methodological quality.

[Trained volunteers to support patients after hospitalization-national implications from international findings]

BACKGROUND

In Germany people over 65 years old are treated in hospital almost twice as often as younger people. Special attention needs to be paid to the transition from inpatient to outpatient care. In recent years, volunteers have been increasingly involved in the care of older patients during and after the hospitalization phase.

OBJECTIVE

This article presents the results of empirical studies, which evaluated one-to-one approaches with trained volunteers to support chronically ill, multimorbid older patients at the interface between hospital and domestic care. Implications for the German care system are derived for the first time.

MATERIAL AND METHODS

The results of a systematic search for randomized controlled studies, controlled studies and studies in a one-group pre-post design are presented. The identified interventions are presented, a cautious assessment of the need for care based on representative national surveys is made and the added value of the interventions is assessed against the background of the existing care structures.

RESULTS

In the international context, trained volunteers are active in psychosocial coordinative support (n = 2), physical cognitive activation (n = 4) and assistance with medication intake (n = 2). These interventions show short-term effects with small and medium effect sizes. Psychosocial coordinative support and physical cognitive activation are basically transferable to national circumstances.

DISCUSSION

Before a broad implementation, the approaches would first have to be adapted to national circumstances, tested for feasibility and the effectiveness must be examined in high-quality studies.

Effect of an educational intervention on breastfeeding knowledge and attitude among interns at Cairo University Hospital

BACKGROUND

Professional advice provided to mothers has an effective role on the prevalence and duration of breastfeeding. Previous studies showed that health care providers had defective knowledge and skills necessary to promote and support breastfeeding.

AIM

To assess breastfeeding-related knowledge and attitude among interns at Cairo University Hospital, before and after the provision of breastfeeding educational training sessions.

MATERIALS AND METHODS

The first phase was a cross-sectional study, conducted in Cairo University Hospital (Kasr Al Ainy) among 137 interns. The second phase was a pre-post interventional design. A pretested self-administered questionnaire was used to explore breastfeeding-related knowledge and attitude before, immediately after, and 3 months after breastfeeding educational sessions.

RESULTS

Participants' mean age was 23.7 ± 0.81, (range 22-27 years), with equally distributed males and females. The median total knowledge percent score was 56.4 (45.2-64.5). The highest median subtotal knowledge percent score was for effective feeding 100 (100-100), and the least median was for breast milk expression 20 (0:40). Participants' knowledge improved after the educational intervention: The subtotal knowledge scores showed a statistically significant improvement immediately after and 3 months after the intervention in the following items: advantages for the baby, colostrum, duration, complementary feeding, and breast milk expression. The median total attitude percent score was 80 (74.1-83.5) and significantly improved immediately after the intervention.

CONCLUSION

Baseline knowledge and attitude scores among interns significantly improved after the intervention. Therefore, adoption of different curricular and extracurricular activities to improve breastfeeding knowledge and skills is required.

The Role of a Community-Based Intervention in Promoting Helmet Use in a Non-probability Sample of Rural Motorcyclists in Iran

Although the use of helmets is known to prevent the majority of mortalities by head injuries, it is ignored by a large number of motorcyclists. The present study was conducted to promote helmet use in an attempt to reduce injuries among motorcyclists in a rural area by adopting a community-based participation approach. The one-group pretest-posttest pre-experimental design was conducted in northwest Iran. The study was conducted in three phases: (1) baseline measurement, (2) implementation of the intervention, and (3) assessment of the outcomes. The intervention included the distribution of learning tools, education of various community groups, tightening of driving laws for offending motorcyclists, promotional programs at community level, and utilizing all opportunities to discuss the benefits of helmets. Due to the non-experimental nature of the study, no causal inferences were drawn. After the intervention, the percentage of the awareness of the benefits of helmet use was increased by 28%, positive attitudes towards benefits of helmet use was increased by 32.6%, and supporting helmet use was increased by 58.6%. Moreover, helmet sale and use increased by 147.0% and 32.0%, respectively. Additionally, motorcycle accidents, head injuries, and mortalities were decreased by 71.8, 55.5, and 60.0%, respectively. Community-based participation approach may positively influence health promoting behaviors and motorcyclists' decisions to wear helmet in rural areas.

Assessment of Efficacy of Virtual Reality Distraction in Reducing Pain Perception and Anxiety in Children Aged 6-10 Years: A Behavioral Interventional Study

Aim

The aim of the present study was to assess the effectiveness of virtual reality distraction on pain perception and state anxiety levels undergoing restorative treatment in children.

Materials and methods

This was an interventional study with 30 children of age 6-10 years came to the Department of Pedodontics and Preventive Dentistry. The intervention was distraction with virtual reality eyeglasses and the parameters considered includes pain perception analyzed subjectively by Wong Baker FACES pain rating scale and objectively by FLACC scale; anxiety was analyzed physiologically by measuring pulse rate and oxygen saturation levels using pulse oximeter. The parameters were recorded before the treatment, i.e., baseline, during and as well as after the restorative treatment procedure. The values noted were tabulated and subjected to appropriate statistical analysis with p value set at 0.05.

Results

The study displayed a very high statistical significance in reduction of pain perception and anxiety levels in all the comparisons made at three time periods, i.e., baseline, during and after treatment procedure (p < 0.0001).

Conclusion

Virtual reality distraction can be considered as a budding distraction tool in the arena of behavior management that helps adapt the child to dental environment and able to deliver qualitative dental care.

Clinical significance

Managing an anxious child is one of the challenging tasks for a pediatric dentist in the day-to-day life. As the world progresses with newer interventions, virtual reality distraction is one among them that has the ability to reduce pain perception and anxiety in children with a positive approach.

How to cite this article

Rao DG, Havale R, Nagaraj M, et al. Assessment of Efficacy of Virtual Reality Distraction in Reducing Pain Perception and Anxiety in Children Aged 6-10 Years: A Behavioral Interventional Study. Int J Clin Pediatr Dent 2019;12(6):510-513.

Comparison and Evaluation of Attitude and Knowledge Towards the Management of Dental Injury in School Teachers Before and After Oral Health Education

Background

Dental traumatic injuries are prevalent in school-going children. Therefore, It is critical to ascertain the knowledge and practices of school teachers who are in close contact with these children.

Aim

To evaluate the knowledge and attitude of school teachers toward dental trauma and the effect of the educational intervention.

Materials and methods

The interventional study was designed by two-stage cluster sampling. A total of 158 teachers were part of the research. Data was collected through a pretested questionnaire. Re-evaluation was done after an informative lecture. Results were statistically analyzed.

Result

The knowledge was consistently lacking prior to intervention with the level of correct answer ranging from 0.6 to 56.3%. It improved significantly post education ranging up to 96.6%. A positive attitude was noticed even before the intervention was employed.

Conclusion

Study observes a significant knowledge gap regarding the primary management of dental injuries amongst school teachers and emphasizes the need for urgent educational intervention to fill in this gap.

Clinical significance

Suggestions derived from this study are especially important in today’s scenario where, the concept of conservation, retention, prevention and early intervention of tooth structures is topmost of all the priorities.

How to cite this article: Nashine N, Bansal A, Tyagi P, Jain M, Jain A, Tiwari U. Comparison and Evaluation of Attitude and Knowledge towards the Management of Dental Injury in School Teachers Before and After Oral Health Education. Int J Clin Pediatr Dent. 2018;11(5):425-429.

Emergency Department influenza vaccination campaign allows increasing influenza vaccination coverage without disrupting time interval quality indicators

To evaluate the impact of an influenza vaccination (IV) coverage (IVC) in a vaccination campaign of an Emergency Department (EDVC) and its impact on ED time interval quality indicators. We conducted a 4 year observational study, with an intervention during the 4th year. IVC was calculated during pre-and early-epidemic periods. During the final period, a 12 weeks EDVC was implemented. Physicians and nurses were trained and sensitized in the importance of vaccination, and their role in the prevention of severe forms of influenza was reinforced. The vaccine was proposed by physicians and nurses, and delivered by them. Repeated measures ANOVA is a validated method for related not independent groups ( https://statistics.laerd.com/statistical-guides/repeated-measures-anova-statistical-guide.php ). Overall, IVC was 987/3191 (30.9%) with an increasing trend from 28.8 to 33.2%. In the fourth period, out of 868 patients identified with IV indication, 288 had already been vaccinated (IVC 33.2%). After excluding patients presenting criteria of exclusion, IV was proposed to 475 patients: 317 (66.7%) accepted. The vaccination rate after patient's acceptance was 89.6% (288/317). At the end of the EDVC, influenza vaccination coverage was 572 (284 + 288)/868 (65.9%). The delay between arrival at the ED and seeing the triage nurse and physician as well as the overall ED length of stay were not modified during the study period and before and during EDVC. EDVC effectively doubled the influenza vaccination coverage, without modifying ED time interval quality indicators.

Main changes in European Clinical Trials Regulation (No 536/2014)

The new Regulation (EU) No. 536/2014 for clinical trials of medicinal products for human is part of a European regulatory framework in which the European Commission has wished to give a strong impetus to scientific research and industrial progress. It is a new regulation that fills a series of regulatory gaps in the Clinical Trials through the creation of a uniform framework for the authorization of clinical trials by all interested Member States with a single assessment of the results. The Regulation thus facilitates cross-border cooperation to make the clinical tests wider and encourage the development of special treatments, for example for rare diseases, but above all streamlines the rules on clinical trials across European Union (EU), introducing simplified rules for experimentation so-called 'low level of intervention', on which much has been discussed and still arouses concern, providing for authorized medicines or used off-label in the presence of scientific evidence published on efficacy and safety and to benefit from they will be mainly the pediatric and oncological therapeutic areas. The applications and any communication will be submitted paperlessly via a new electronic EU portal. The complex processing procedures and shorter time limits are to be stressed in comparison to the previously valid regulations. This is a major challenge for all stakeholders, but on the other hand it should contribute to the future role of the EU in the development of innovative medicines.

Design of interventional studies in thoracic surgery

Interventional studies differ from observational studies in that one or more specific interventions are evaluated. Randomized controlled trials remain the gold standard for interventional studies and can take different forms. In surgical studies, the three types of randomized controlled trials most commonly encountered are: (I) trials that compare two different medical treatments for patients undergoing surgery; (II) trials that evaluate two different surgical techniques and (III) studies that compare surgery vs. non-operative management. When an intervention is to be evaluated but a randomized controlled trial is not feasible, alternative interventional study designs may be considered.

Interactive Multimedia Training in Osteoporosis Prevention of Female High School Students: An Interventional Study

Given the limitations of traditional teaching methods in the learning process of adolescents, this study was designed to investigate the effects of osteoporosis prevention training through interactive multimedia method on the degree of knowledge and self-efficacy of female high school students. In this interventional study which was conducted in 2016 in Fars province, Iran, 120 high school students were selected through proportional stratified sampling from schools and different classes at first, second, third, and pre-university grades. The participants were randomly divided into two groups, each containing 60 students. Educational interventions for the test group included an interactive multimedia CD, and for the control group was an educational booklet. Before and one month after the intervention the students' level of knowledge and self-efficacy was measured. The spss 19 statistical software was used, and descriptive and analytical tests were performed to analyze the data. Results showed a significant difference in self-efficacy scores after the intervention (P=0.012) with the test group obtained a higher self-efficacy score than the control group. Also, a significant increase was observed in the knowledge score of both groups after the training (P<0.001), but the knowledge score between the two groups was not statistically significant (P=0.38) after the intervention. The use of new training methods like interactive multimedia CD for public education, particular adolescents about health and hygiene is recommended.

A health education booklet and telephone follow-ups can improve medication adherence, health-related quality of life, and psychological status of patients with heart failure

BACKGROUND

Heart failure is an increasing public health problem globally. Interventions are imperative in managing the disease.

OBJECTIVE

To examine the effectiveness of a health education booklet and telephone follow-ups on patients' medication adherence, health-related quality of life, and psychological status.

METHODS

One hundred and sixty heart failure patients were assigned to either the experimental group (health education booklet and telephone follow-ups) or the control group (usual care). An independent t-test and the generalized estimating equation (GEE) model were used to compare the differences in the study outcomes. The statistical tests were two-sided and a p value below 0.05 was considered statistically significant.

RESULTS

The patients in the experimental group showed greater improvement throughout the study period compared with those in the control group regarding all the study outcomes.

CONCLUSIONS

The study provided clues for healthcare professionals to develop interventions while undertaking clinical work with limited resources in China.