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Punga AR, Westerberg E, Åsenlöf P. Implementation of tailored exercise programs for MG patients in a gym setting: a pragmatic feasibility case study. Neuromuscul Disord 2023; 33:334-338. [PMID: 36931100 DOI: 10.1016/j.nmd.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Although supervised aerobic and resistance training in a hospital setting was proven safe and beneficial for well-controlled myasthenia gravis (MG) patients, implementation of similar programs in the community has not been studied. We conducted a pragmatic open-label study at a large gym in Uppsala, Sweden. Seven patients with generalized MG were recruited to participate in an individualized, tailored exercise program, based on individual baseline status and personal goals, with a personal trainer. All patients completed the entire training period. The individually tailored exercise program was implemented safely and effectively, with all patients improving in aerobic capacity, muscle strength, and balance. Our pragmatic open-label case study suggests that well-controlled patients with generalized MG can extend their physical exercise to personal training in the gym. This is an essential step towards reducing the barriers to implementing exercise procols and increasing the availability of these interventions to MG patients.
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Affiliation(s)
- Anna Rostedt Punga
- Clinical Neurophysiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Elisabet Westerberg
- Clinical Neurophysiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Physiotherapy, Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
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Boonsawat W, Sawanyawisuth K. A real-world implementation of asthma clinic: Make it easy for asthma with Easy Asthma Clinic. World Allergy Organ J 2022; 15:100699. [PMID: 36267099 PMCID: PMC9554822 DOI: 10.1016/j.waojou.2022.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Asthma is a common disease. Although several practice guidelines for asthma exist, good control is still problematic, particularly in developing countries. The Easy Asthma Clinic (EAC) was established in 2004 with the aim of providing simplified asthma guidelines, a multidisciplinary approach, and an online database. This study aimed to evaluate the outcomes of EAC in a real-world setting. Method Clinical data were collected from the EAC database between 2004 and 2017. Treatment data and asthma control data were evaluated during the study period. Results In all, 358 182 patients with asthma were treated at EAC in 1171 hospitals throughout Thailand during the 14-year period. For 3 264 117 visits, inhaled corticosteroid (ICS) was given at the highest percentage (average of 50.00%) with an average percentage of controllers at 75.08% and a trend of increasing treatment (coefficient 0.007; p < 0.001). The percentage of controlled asthma also increased from 20.48% to 27.76% with a coefficient of 0.015 (p for trend <0.001). Conclusion The EAC may facilitate controller use in patients with asthma thereby increasing asthma control according to a large sample size and long longitudinal study.
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Affiliation(s)
| | - Kittisak Sawanyawisuth
- Corresponding author. Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
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Meyer-Lueckel H, Wardius A, Krois J, Bitter K, Moser C, Paris S, Wierichs RJ. Proximal caries infiltration - Pragmatic RCT with 4 years of follow-up. J Dent 2021; 111:103733. [PMID: 34174349 DOI: 10.1016/j.jdent.2021.103733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Efficacy of proximal caries infiltration to arrest lesion progression has been shown in university settings, but only once in a practice-based pragmatic design with a follow-up of 18 months. The aim of this randomized split-mouth placebo-controlled study was to follow-up this cohort for 3 years and those with high caries risk for 4 years. METHODS Originally, in 87 children and young adults pairs of 238 proximal caries lesions, radiographically extending into inner half of enamel (E2) or outer third of dentin (D1), were randomly allocated to two groups: infiltration (Icon; DMG) or mock (control) treatment by five dentists in four private practices. All subjects received risk-related instructions for diet, flossing and fluoridation. The primary outcome was radiographic lesion progression (pairwise comparison) evaluated by two evaluators independently being blinded to treatment allocation. RESULTS After 36 months [mean (SD): 1152 (166) days] 165 lesion pairs in 64 patients as well as after 48 months [mean (SD): 1496 (121) days] 71 lesion pairs in 20 high caries risk patients could be re-evaluated clinically as well as radiographically using individualized bitewing holders as at baseline. No adverse events could be observed. After 36 months, progression was recorded in 23/165 test (14%) and 64/165 control lesions (39%) [McNemar/Obuchowski test; p<0.001; relative risk reduction (CI95%): 64 (45-77%)]. After 48 months lesion progression was recorded in 13/71 test (18%) and 34/71 control lesions (48%) [p = 0.003; relative risk reduction (CI95%): 62 (34-78%)] of high caries risk patients. CONCLUSIONS It can be concluded that also in a practice-setting proximal caries infiltration is more efficacious in reducing lesion progression compared with individualized non-invasive measures alone over a period of four years.
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Thompson JH, Davis MM, Leo MC, Schneider JL, Smith DH, Petrik AF, Castillo M, Younger B, Coronado GD. Participatory Research to Advance Colon Cancer Prevention (PROMPT): Study protocol for a pragmatic trial. Contemp Clin Trials 2018; 67:11-15. [PMID: 29408304 PMCID: PMC5903679 DOI: 10.1016/j.cct.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colon cancer is the second leading cause of cancer deaths in the United States. The Participatory Research to Advance Colon Cancer Prevention (PROMPT) study is a collaboration between two research institutions and a federally qualified health center (FQHC). The study seeks to raise colon cancer screening rates using a direct-mail fecal immunochemical testing (FIT) and reminder program in an FQHC serving a predominantly Latino population in California. METHODS PROMPT is a pragmatic trial enrolling 16 clinics. The study will test automated and live prompts (i.e., alerts, reminders) to a direct-mail FIT program in two phases. In Phase I, we tailored and defined intervention components for the pilot using a community-based participatory research approach called boot camp translation. We then plan to conduct a three-arm patient-randomized comparative effectiveness trial in two pilot clinics to compare 1) automated prompts, 2) live prompts, and 3) a combination of automated plus live prompts to alert and remind patients to complete screening. In Phase II, the adapted best practice intervention will be spread to additional clinics within the FQHC (estimated population 27,000) and assessed for effectiveness. Patient and staff interviews will be conducted to explore receptivity to the program and identify barriers to implementation. DISCUSSION This pragmatic trial applies innovative approaches to engage diverse stakeholders and will test the effectiveness and spread of a direct-mail plus reminder program. If successful, the program will provide a model for a cost-effective method to raise colon cancer screening rates among Latino patients receiving care in FQHCs. TRIAL REGISTRATION National Clinical Trial (NCT) Identifier NCT03167125.
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Affiliation(s)
- Jamie H Thompson
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network (ORPRN), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97239, USA.
| | - Michael C Leo
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - Jennifer L Schneider
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - David H Smith
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - Amanda F Petrik
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | | | | | - Gloria D Coronado
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
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Coronado GD, Vollmer WM, Petrik A, Taplin SH, Burdick TE, Meenan RT, Green BB. Strategies and Opportunities to STOP Colon Cancer in Priority Populations: design of a cluster-randomized pragmatic trial. Contemp Clin Trials 2014; 38:344-9. [PMID: 24937017 DOI: 10.1016/j.cct.2014.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/04/2014] [Accepted: 06/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Colorectal cancer is the second-leading cause of cancer deaths in the United States. The Strategies and Opportunities to Stop Colorectal Cancer (STOP CRC) in Priority Populations study is a pragmatic trial and a collaboration between two research institutions and a network of more than 200 safety net clinics. The study will assess the effectiveness of a system-based intervention designed to improve the rates of colorectal-cancer screening using fecal immunochemical testing (FIT) in federally qualified health centers in Oregon and Northern California. MATERIAL AND METHODS STOP CRC is a cluster-randomized comparative-effectiveness pragmatic trial enrolling 26 clinics. Clinics will be randomized to one of two arms. Clinics in the intervention arm (1) will use an automated, data-driven, electronic health record-embedded program to identify patients due for colorectal screening and mail FIT kits (with pictographic instructions) to them; (2) will conduct an improvement process (e.g. Plan-Do-Study-Act) to enhance the adoption, reach, and effectiveness of the program. Clinics in the control arm will provide opportunistic colorectal-cancer screening to patients at clinic visits. The primary outcomes are: proportion of age- and screening-eligible patients completing a FIT within 12months; and cost, cost-effectiveness, and return on investment of the intervention. CONCLUSIONS This large-scale pragmatic trial will leverage electronic health record information and existing clinic staff to enroll a broad range of patients, including many with historically low colorectal-cancer screening rates. If successful, the program will provide a model for a cost-effective and scalable method to raise colorectal-cancer screening rates.
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Affiliation(s)
- Gloria D Coronado
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
| | - William M Vollmer
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
| | - Amanda Petrik
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
| | - Stephen H Taplin
- National Cancer Institute, Process of Care Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Bethesda, MD 20892-9760, USA.
| | - Timothy E Burdick
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, USA; Department of Family Medicine Oregon Health & Sciences University, 4411 SW Vermont Street, Portland, OR 97219, USA.
| | - Richard T Meenan
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227, USA.
| | - Beverly B Green
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
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Palese A, Baldassar D, Rupil A, Bonanni G, Capellari Maria T, Contessi D, De Crignis L, Vidoni A, Piller Roner S, Zanini A. Maintaining patency in totally implantable venous access devices (TIVAD): a time-to-event analysis of different lock irrigation intervals. Eur J Oncol Nurs 2013; 18:66-71. [PMID: 24100090 DOI: 10.1016/j.ejon.2013.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/16/2013] [Accepted: 09/03/2013] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the effectiveness of irrigating totally implantable venous access devices (TIVADs) every eight weeks instead of every four in maintaining the patency of the device. METHODS An explorative, pragmatic, prospective study design was conducted in two day hospital centres located in the northeast of Italy, from January 2011 to September 2012. Twenty patients who had skipped an appointment and were thus washing their TIVAD every eight weeks (exposed) were included, as were 17 patients following the typical wash regimen of every four weeks (controls). TIVAD occlusion-defined as the inability of the device to aspirate blood and/or the inability to properly irrigate the device-was the principal study end-point. RESULTS A total of six occlusions were documented in six patients. Four cases were observed among the exposed group (4/20; 20.0%), while two were observed among the control group (2/17; 11.7%). No statistically significant differences were observed in the occurrence of occlusion between the groups (RR: 1.29, 95%CI: 0.67-2.50, p = 0.49). No statistically significant differences emerged between groups in the time that elapsed from study inclusion to occlusion occurrence according to the time-to-event analysis performed using the Kaplan-Meier estimation model (Log Rank [Mantel-Cox] = χ(2) 0.284, df 1, p = 0.594). CONCLUSIONS Within the limitations of the study which should be addressed with further research based on double-blinded randomised clinical trials, postponing the irrigation regimen of TIVADs to eight weeks seems to be sufficient to maintain device patency.
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Affiliation(s)
- Alvisa Palese
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy.
| | - Debra Baldassar
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Alessandro Rupil
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Graziella Bonanni
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Teresa Capellari Maria
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Daniela Contessi
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Laura De Crignis
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Adriana Vidoni
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Sonia Piller Roner
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Antonietta Zanini
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
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