132 research outputs found

    De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after study

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    Background: Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. Methods: In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. Findings: Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22路0%, 95% CI 20路0 to 24路0) of 1665 patients in the baseline group and in 275 (14路4%, 12路8 to 16路0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0路65, 95% CI 0路56 to 0路77, p<0路0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6路65% (95% CI 2路47 to 10路82, p=0路011). Inappropriate use of urinary catheters occurred in 105 (32路4%, 95% CI 27路3 to 37路8) of 324 patients in the baseline group compared with 96 (24路1%, 20路0 to 28路6) of 398 patients in the intervention group (IRR 0路74, 95% CI 0路56 to 0路98, p=0路013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6路34% (95% CI 鈭12路46 to 25路13, p=0路524). Interpretation: Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. Funding: Netherlands Organisation for Health Research and Development

    Factors associated with trial recruitment, preferences, and treatments received were elucidated in a comprehensive cohort study

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    Objectives: Recruitment to pragmatic trials is often difficult, and little is known about factors associated with key participation and treatment decisions. These were explored in the Prostate cancer testing and Treatment (ProtecT) study. Study Design and Setting: Baseline sociodemographic, patient-reported outcome, clinical history, and prostate cancer biopsy data were collected for all patients eligible to take part in the ProtecT trial, in a comprehensive cohort design. Men who rejected randomization specified a preferred option and were followed up identically to the randomized cohort. Factors associated with participation decisions, patient preferences, and reasons for changing treatment were explored. Results: Of 2,664 men with clinically localized prostate cancer, 997 (37%) rejected randomization. Their treatment preferences and subsequent treatment choices/changes in both randomized and treatment choice cohorts were strongly associated with prostate cancer risk features: toward active monitoring for low-risk disease and toward radical options with higher risk prostate cancer. Among many factors measured, only a small number of weak associations were found for occupation groups and some patient symptoms. Similar percentages changed from the random allocation and initially stated preference. Conclusion: The comprehensive cohort design provided new insights into trial recruitment and participation decisions. Opportunities to improve recruitment by supporting recruiters with equipoise and patient preferences were identified

    Pessary for preterm birth prevention in twin pregnancy with short cervix : 3-year follow-up study

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    OBJECTIVE: We recently found in a randomized clinical trial (ProTWIN) that cervical pessary prevented preterm birth and improved neonatal outcome in women with a multiple pregnancy and a cervical length (CL) <38mm. In this follow-up study we evaluated long-term developmental outcomes in the offspring of these women at three years corrected age. METHODS: We conducted a follow-up study of the ProTWIN trial, a trial in which between 2009 and 2012 asymptomatic women with a multiple pregnancy had been randomized to pessary or no pessary. Our current follow-up and analysis was limited to mothers with a midtrimester CL< 38mm (78 and 55 mothers, 157 and 111 children in the pessary and control group, respectively). At 3 years of corrected age, surviving children were invited for a Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) assessment. We compared death after randomization or neurodevelopmental disability (Bayley score of 鈮 85, 1SD below mean) rates between pessary and controls according to intention-to-treat principle and using multiple imputation for missing data. We compared mean Bayley-III scores in surviving children. A linear mixed effects model was used to adjust for correlation between children of one mother. RESULTS: In total 27 children had died (6 pessary vs 21 control group, 5% versus 26%, adjusted odds ratio (aOR) 0.14; [95% CI 0.04 to 0.50]). Bayley-III outcomes were collected for 173 out of 241 (72%) surviving children (114 (75%) pessary vs 59 (66%) control group). The cumulative incidence of death or survival with a neurodevelopmental disability was 12 (10%) vs 23 (29%) in pessary and control group respectively; aOR 0.26 [95% CI 0.09 to 0.75]. We found neither statistical nor clinically relevant differences in cognitive, language and motor development among surviving children between both groups. Comparable results were found after multiple imputation. CONCLUSION: In women with a twin pregnancy and a CL < 38 mm, the use of cervical pessary strongly improved survival of the children without affecting neurodevelopmental disability at three years corrected age

    Pessary for preterm birth prevention in twin pregnancy with short cervix : 3-year follow-up study

    No full text
    OBJECTIVE: We recently found in a randomized clinical trial (ProTWIN) that cervical pessary prevented preterm birth and improved neonatal outcome in women with a multiple pregnancy and a cervical length (CL) <38mm. In this follow-up study we evaluated long-term developmental outcomes in the offspring of these women at three years corrected age. METHODS: We conducted a follow-up study of the ProTWIN trial, a trial in which between 2009 and 2012 asymptomatic women with a multiple pregnancy had been randomized to pessary or no pessary. Our current follow-up and analysis was limited to mothers with a midtrimester CL< 38mm (78 and 55 mothers, 157 and 111 children in the pessary and control group, respectively). At 3 years of corrected age, surviving children were invited for a Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) assessment. We compared death after randomization or neurodevelopmental disability (Bayley score of 鈮 85, 1SD below mean) rates between pessary and controls according to intention-to-treat principle and using multiple imputation for missing data. We compared mean Bayley-III scores in surviving children. A linear mixed effects model was used to adjust for correlation between children of one mother. RESULTS: In total 27 children had died (6 pessary vs 21 control group, 5% versus 26%, adjusted odds ratio (aOR) 0.14; [95% CI 0.04 to 0.50]). Bayley-III outcomes were collected for 173 out of 241 (72%) surviving children (114 (75%) pessary vs 59 (66%) control group). The cumulative incidence of death or survival with a neurodevelopmental disability was 12 (10%) vs 23 (29%) in pessary and control group respectively; aOR 0.26 [95% CI 0.09 to 0.75]. We found neither statistical nor clinically relevant differences in cognitive, language and motor development among surviving children between both groups. Comparable results were found after multiple imputation. CONCLUSION: In women with a twin pregnancy and a CL < 38 mm, the use of cervical pessary strongly improved survival of the children without affecting neurodevelopmental disability at three years corrected age

    Atosiban versus fenoterol as a uterine relaxant for external cephalic version: randomised controlled trial

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    To compare the effectiveness of the oxytocin receptor antagonist atosiban with the beta mimetic fenoterol as uterine relaxants in women undergoing external cephalic version (ECV) for breech presentation. Multicentre, open label, randomised controlled trial. Eight hospitals in the Netherlands, August 2009 to May 2014. 830 women with a singleton fetus in breech presentation and a gestational age of more than 34 weeks were randomly allocated in a 1:1 ratio to either 6.75 mg atosiban (n=416) or 40 渭g fenoterol (n=414) intravenously for uterine relaxation before ECV. The primary outcome measures were a fetus in cephalic position 30 minutes after the procedure and cephalic presentation at delivery. Secondary outcome measures were mode of delivery, incidence of fetal and maternal complications, and drug related adverse events. All analyses were done on an intention-to-treat basis. Cephalic position 30 minutes after ECV occurred significantly less in the atosiban group than in the fenoterol group (34% v 40%, relative risk 0.73, 95% confidence interval 0.55 to 0.93). Presentation at birth was cephalic in 35% (n=139) of the atosiban group and 40% (n=166) of the fenoterol group (0.86, 0.72 to 1.03), and caesarean delivery was performed in 60% (n=240) of women in the atosiban group and 55% (n=218) in the fenoterol group (1.09, 0.96 to 1.20). No significant differences were found in neonatal outcomes or drug related adverse events. In women undergoing ECV for breech presentation, uterine relaxation with fenoterol increases the rate of cephalic presentation 30 minutes after the procedure. No statistically significant difference was found for cephalic presentation at delivery. Dutch Trial Register, NTR 187

    Innovative treatment modalities for urinary incontinence: a European survey identifying experience and attitude of healthcare providers

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    Introduction and hypothesis Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers鈥 experience with and attitude towards innovative care options. Methods We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Results Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Conclusions Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice.Peer ReviewedPostprint (published version
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