SMART: Self-Management of Anticoagulation,a Randomised Trial [ISRCTN19313375]

Background  

Oral anticoagulation monitoring has traditionally taken place in secondary care because of the need for a laboratory blood test, the international normalised ratio (INR). The development of reliable near patient testing (NPT) systems for INR estimation has facilitated devolution of testing to primary care. Patient self-management is a logical progression from the primary care model. This study will be the first to randomise non-selected patients in primary care, to either self-management or standard care.     

次声对豚鼠凝血功能的影响

目的 研究16 Hz、120 dB,16 Hz、125 dB次声暴露后豚鼠凝血功能的变化规律,探讨次声造成生物体循环系统损害的机制.方法 将豚鼠分为对照组及16 Hz、120 dB,16 Hz、125 dB 2个暴露组,每个暴露组均按暴露时间再分成1、7、14、21 d 4个时间亚组,每个亚组8只豚鼠.各个暴露亚组每日暴露1.5 h,分别连续暴露相应的天数后抽取血样测定凝血功能相关指标及血清中一氧化氮(NO)含量.结果 16 Hz、125 dB组凝血酶原时间(PT)、国际标准化比率(INR)分别为(31.16±3.05)s和2.53±1.21,较对照组[(21.36±0.10)s、1.65±0.07]明显延长,差异有统计学意义(P＜0.05);血清中NO含量[(88.304±52.601)μmol/L]较对照组[(30.943±26.864)μmol/L]明显升高,差异有统计学意义(P＜0.05).16 Hz、125 dB组暴露14 d时PT和INR较对照组明显延长,并持续至第21天.16 Hz、125 dB组暴露7 d时血清中NO含量较对照组明显升高,且第14天继续升高,差异均有统计学意义(P＜0.05),21天时有下降趋势.结论 16 Hz、125 dB次声暴露后豚鼠凝血功能减退,INR及PT可做为评价次声对凝血功能影响的指标.

Abstract：

Objective To study the change of the blood coagulation function of guinea pigs exposed to 16 Hz/120 dB, 16 Hz/125 dB infrasound and to explore the mechanism of circulation system damage.Methods Seventy-two guinea pigs were divided into 3 groups: the control group, the group exposed to 16 Hz/120 dB infrasound for 1.5 h a day and the group exposed to 16 Hz/125 dB infrasound for 1.5 h a day. Each exposure group was divided into 4 sub-groups (8 guinea pigs a sub-group) which were exposed to infrasound for 1, 7, 14 and 21 d, respectively. The coagulation function and serum nitric oxide (NO) were measured for control group and all sub-groups after exposure to infrasound. Results The prothrombin time (PT),international normalized ratio (INR) and serum NO of group exposed to 16 Hz/125 dB infrasound were (31.16±3.05) s, 2.53±1.21 and (88.304±52.601)μmol/L, respectively, which were significantly higher than those [(21.36±0.10) s, 1.65±0.07 and (30.943±26.864) μ mol[L] of control group (P＜0.05). PT and INR of sub-groups exposed to 16 Hz/125 dB infrasound for 14 and 21 d were significantly higher than those of control group. NO of sub-groups exposed to 16 Hz/125 dB infrasound for 1 week and 2 weeks were significantly higher than that of control group (P＜0.05), but NO of sub-group exposed to 16 Hz/125 dB infrasound for 3 weeks decreased slightly. Conclusion The blood coagulation function of guinea pigs exposed to 16 Hz/125 dB infrasound decreased, PT and INR may be used as the indexes to assess of blood coagulation function change induced by the infrasound exposure.     

A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study

Background  

Shorter periods of hospitalisation and increasing warfarin use have placed stress on community-based healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC) International Normalised Ratio (INR) testing by a trained pharmacist improved patients' outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting.     

Can diagnostic self-testing of laypeople be predicted by core concepts of health behaviour theories? A comparison between German self-testers and non-self-testers

Aim

A broad range of self-tests (testing for e.g. HIV, cancer, hepatitis B/C) is available on the Internet and can be conducted by lay consumers without the help of a health professional. However, little is known about the determinants of self-testing. The aims of this study were to investigate whether the use of self-tests can be predicted by (1) factors specified in social-cognitive health behaviour theories; (2) technological affinity; or (3) anticipated affect.

Subjects and methods

An online survey was conducted to investigate social-cognitive health concepts, technological affinity, and anticipated affect as predictors of self-testing. Participants were invited in batches, representative of the age and gender distribution in Germany, until similar numbers of completed cases of non-self-testers (n?=?512) and self-testers (n?=?505) were reached. Univariate and multiple hierarchical logistic regression analyses were carried out.

Results

Self-testing was significantly associated with self-test-related self-efficacy, perceived severity, perceived susceptibility, and to some degree with outcome expectancy. Technological competence acted as a suppressor variable, tending to enhance the predictive value of self-test-related self-efficacy. Participants who anticipated a positive self-test-related affect were more likely to be self-testers than non-self-testers.

Conclusions

Self-testing was predicted by the common health psychological constructs. However, including technological affinity and anticipated affect into the model significantly improved the predictive value of the use of self-tests. Given the current shortage of physicians, especially in rural areas, the need for, and actual use of self-tests could increase in Germany in the future. Thus, follow-up studies investigating the emotional consequences of self-testing are needed.

     

A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy

Objective

To compare patient profiles and health care use for physician-referred and self-referred episodes of outpatient physical therapy (PT).

Data Source

Five years (2003–2007) of private health insurance claims data, from a Midwest insurer, on beneficiaries aged 18–64.

Study Design

Retrospective analyses of health care use of physician-referred (N = 45,210) and self-referred (N = 17,497) ambulatory PT episodes of care was conducted, adjusting for age, gender, diagnosis, case mix, and year.

Data Collection/Extraction

Physical therapy episodes began with the physical therapist initial evaluation and ended on the last date of service before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of PT.

Principal Findings

The self-referred group was slightly younger, but the two groups were very similar in regard to diagnosis and case mix. Self-referred episodes had fewer PT visits (86 percent of physician-referred) and lower allowable amounts ($0.87 for every $1.00), after covariate adjustment, but did not differ in related health care utilization after PT.

Conclusions

Health care use during PT episodes was lower for those who self-referred, after adjusting for key variables, but did not differ after the PT episode.     

Reasons for self-testing—beyond the passive users. Results from a nationwide sample in Germany

Objectives

The aims of this study were to investigate (1) the personal reasons for using a self-test, (2) the decisive motives for self-testing, and (3) why a self-test was preferred over a conventional diagnosis by a health professional.

Subject and methods

Participants were invited to an online survey in batches representative of the age and gender distribution in Germany. The research questions were investigated with open questions and questions with given responses. Qualitative content analysis was conducted based on the method described by Mayring.

Results

Overall, 980 personal reasons for conducting 709 self-tests were indicated by 505 self-testers, which were assigned to 13 main categories with 32 sub-categories. The two most frequently stated personal reasons for self-testing were ‘uncertainty/reassurance’ and ‘risk perception’ (e.g. hereditary risks, previous diseases). The decisive reason for self-testing was strongly associated with the disease the user expected to detect. Self-tests were preferred over a diagnosis by a health professional because of practical advantages.

Conclusions

The majority of the German testers actively sought a self-test. Self-testers’ follow-up behaviour and their emotional perceptions need to be investigated.

     

Understanding patient acceptance and refusal of HIV testing in the emergency department

Background  

Despite high rates of patient satisfaction with emergency department (ED) HIV testing, acceptance varies widely. It is thought that patients who decline may be at higher risk for HIV infection, thus we sought to better understand patient acceptance and refusal of ED HIV testing.     

通过HIV/梅毒联合自我检测促进男男性行为人群进行梅毒检测的效果研究

目的:评估HIV/梅毒联合自我检测（自检）在促进MSM梅毒检测方面的作用。方法:2019年7月通过淡蓝网（https：//www.danlan.org）招募研究对象,将符合纳入标准的研究对象按照1∶1∶1随机分为3组：HIV/梅毒联合自检组、彩票激励自检组和对照组。对HIV/梅毒联合自检组和彩票激励自检组通过网络邮寄H...     

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study

Objective

To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.

Data Sources

EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021).

Study Design

We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.

Data Extraction

We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.

Principal Findings

In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.

Conclusions

Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.     

两种HIV自我检测模式在促进男男性行为人群HIV检测中的作用

目的:评价两种不同HIV自我检测（自检）模式在促进MSM HIV检测中的作用。方法:采用两种HIV自检模式,一是以性健康促进网络平台为主体的线上HIV自检模式（常规自检模式）;二是鼓励申请者申请多份自检试剂并将其传递给身边朋友的HIV自检模式（自检二次传递模式）。比较两种自检模式中,申请者与受赠者在人口学特征、使用数、...     

Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India

Background

Control of sexually transmitted infections (STIs) is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services.

Methods

Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated.

Results

18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199). The economic cost of treating each STI varied 5-fold from Indian Rupees (INR) 225.5 (US$ 4.91) to INR 1201.5 (US$ 26.15) between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94). The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88). Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p < 0.001, R² = 0.81; power function). With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21) and for each follow-up visit was INR 3.75 (US$ 0.08). Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be handled, which could increase the total STI cases treated at the 14 clinics combined by 38% at an additional cost of only 3.5% for service provision.

Conclusion

There is un-utilised capacity in the public sector STI clinics in this Indian state. Efforts to facilitate utilisation of this capacity would be useful, as this would enable more poor patients with STIs to be served at minimal additional cost, and would also reduce the cost per STI treated leading to more efficient use of public resources.     

A patient decision aid for risk‐reducing surgery in premenopausal BRCA1/2 mutation carriers: Development process and pilot testing

Background

BRCA1/2 mutation carriers’ choice between risk‐reducing salpingo‐oophorectomy (RRSO) and salpingectomy with delayed oophorectomy is very complex. Aim was to develop a patient decision aid that combines evidence with patient preferences to facilitate decision making.

Design

Systematic development of a patient decision aid in an iterative process of prototype development, alpha testing by patients and clinicians and revisions using International Patient Decision Aid Standards (IPDAS) quality criteria. Information was based on the available literature and current guidelines. A multidisciplinary steering group supervised the process.

Setting and participants

Pre‐menopausal BRCA1/2 mutation carriers choosing between RRSO and salpingectomy with delayed oophorectomy in Family Cancer Clinics in the Netherlands.

Main outcome measures

IPDAS quality criteria, relevance, usability, clarity.

Results

The patient decision aid underwent four rounds of alpha testing and revisions. Finally, two paper decision aids were developed: one for BRCA1 and one for BRCA2. They both contained a general introduction, three chapters and a step‐by‐step plan containing a personal value clarification worksheet. During alpha testing, risk communication and information about premature menopause and hormone therapy were the most revised items. The patient decision aids fulfil 37 of 43 (86%) IPDAS criteria for content and development process.

Discussion and conclusions

Both BRCA1/2 mutation carriers and professionals are willing to use or offer the developed patient decision aids for risk‐reducing surgery. The patient decision aids have been found clear, balanced and comprehensible. Future testing among patients facing the decision should point out its effectiveness in improving decision making.     

Efficiency of static and computer adaptive short forms compared to full-length measures of depressive symptoms

Purpose  

Short-form patient-reported outcome measures are popular because they minimize patient burden. We assessed the efficiency of static short forms and computer adaptive testing (CAT) using data from the Patient-Reported Outcomes Measurement Information System (PROMIS) project.     

男男性行为人群利用艾滋病病毒抗体唾液快速检测试剂自检的可接受性调查

目的 评估MSM对HIV抗体口腔黏膜渗出液检测试剂自检（口腔自检）方式检测HIV的可接受度。方法 2013年4月至2014年4月在北京市和南宁市招募MSM进行基线和随访调查，包括问卷调查、HIV血清学检测（HIV血检）和口腔快检自检。通过平行对比血检和口腔自检得到口腔自检的灵敏度和特异度，通过logistic回归模型评估MSM对口腔快检的可接受度和相关影响因素。结果 510名MSM参加基线调查，其中279名接受门诊随访调查。基线MSM口腔自检的灵敏度86.00%（43/50），特异度98.23%（445/453）。基线MSM中有78.63%（401/510）报告在本次研究后有口腔自检HIV的意愿，相关因素包括最近6个月与固定性伴不使用安全套肛交（aOR=0.30，95% CI：0.10～1.00）和首选检测方式为口腔快检（aOR=7.32，95% CI：1.61～33.31）。相较血检，基线MSM中34.51%（176/510）报告更倾向于进行口腔快检，相关因素为出生地在城市。结论 中国两城市MSM对HIV口腔自检方式可接受度高。     

Missed opportunities for earlier HIV testing and diagnosis at the health facilities of Dessie town,North East Ethiopia

Background  

For patients in all health-care settings HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines. The nation's physicians and other health care providers should assume a much more active role in promoting HIV testing. The aim of this study was to investigate the extent to which missed opportunities for earlier HIV testing and diagnosis occur in the health facilities of north east Ethiopia.     

基于男性社交平台男男性行为人群HIV检测率及HIV自我检测率变化趋势分析

目的:了解我国MSM的HIV检测率尤其是HIV自我检测（自检）率的变化趋势,初步评估HIV自检在扩大MSM的HIV检测方面的作用。方法:通过Blued男性社交平台在全国范围内招募研究对象,调查内容包括社会人口学特征、性行为、既往HIV检测与自检等,并对历年数据进行趋势性分析。结果:2013-2016、2018年,分别招...     

The role of prothrombin time (PT) in evaluating green pit viper (Cryptelytrops sp) bitten patients

Viper bites cause consumptive coagulopathy resulting in hypofibrinogenaemia. Whole-blood clotting time is a standard test used to assess bleeding risk. Prothrombin time (PT) and activated partial thromboplastin time (APTT) are better standardised assays that are widely available, but their diagnostic accuracy in viper bites remains unknown. Adult patients presumed bitten by green pit vipers (Cryptelytops sp.) were enrolled. Conventional venous clotting time (VCT), 20min whole-blood clotting time (20WBCT), PT with international normalized ratio (INR) and APTT were determined. A fibrinogen level below 1.0g/litre was used as the gold standard. There were 97 patients. The average age was 46.1 years and 49.5% were men. VCT >30min, INR >1.2 and fibrinogen level <1.0g/litre were found in 9.3, 10.3 and 7.2%, respectively. The sensitivities of VCT >30min, 20WBCT (N=55), INR and APTT were 57.0%, 85.7%, 85.7% and 57.1%, respectively. The respective specificities were 94.4%, 95.8%, 95.6% and 72.4%. Three hypofibrinogenaemic patients who did not receive antivenom because of VCT <30min had persistently normal VCT and went home without clinical bleeding. In conclusion, PT with INR can be an alternative test for evaluation of coagulopathy in green pit viper bitten patients with potentially improved inter-laboratory standardisation.     

Canadian physiotherapists' views on certification, specialisation, extended role practice, and entry-level training in rheumatology

Background  

Since the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new arthritis care models, some of which involve physiotherapists (PT) working in extended roles. However, little is known about PTs' interests in these new roles. The primary objective of this survey was to determine the interests among orthopaedic physiotherapists (PTs) in being a certified arthritis therapist, a PT specialized in arthritis, or an extended scope practitioner in rheumatology, and to explore the associated factors, including the coverage of arthritis content in the entry-level physiotherapy training.     

Enhancing quality of life in older adults: A comparison of muscular strength and power training

Background  

Although progressive resistance strength training (ST) has been found to improve various measures of physical functioning in older adults, the benefit to quality of life is unclear. Additionally, recent evidence suggests that high velocity power training (PT) may be more beneficial for physical functioning than ST, but it is not known whether this type of training impacts quality of life. The purpose of this study was to compare changes in multiple measures of quality of life resulting from ST vs. PT in older adults. A no exercise group was also included as control comparison condition.