Effects of iPad Video Education on Patient Knowledge, Satisfaction, and Cardiac Rehabilitation Attendance.

PURPOSE: The purpose of this project was to examine the outcomes of using video education as an adjunct to standard discharge education for patients receiving percutaneous coronary intervention. Outcomes included knowledge about heart disease and discharge instructions, satisfaction with the video education, and the percentage of patients with cardiac rehabilitation referrals who attended their first cardiac rehabilitation session. METHODS: This project analyzed data on 224 participants. A video delivered via an iPad was used to provide adjunct discharge education to patients who underwent percutaneous coronary intervention procedures and were on the 24-hour overnight postrecovery unit. Participants completed a test to gauge knowledge learned. Descriptive statistics, the paired t test, and the Fisher exact test were used to evaluate the efficacy of this education. RESULTS: A paired t test showed significant knowledge improvement between the pretest percentage correct (mean = 88.97) and the posttest (mean = 96.62): t = -9.657, df = 223, P < .001. A majority of the patients (86.3%, n = 183) were very satisfied with the video education, and 98.1% (n = 208) stated it improved their knowledge and confidence about caring for their heart disease. Despite these reported improvements, there was no significant increase in cardiac rehabilitation attendance (P = .80). CONCLUSION: Patients of all ages embraced the use of video education on iPads as an adjunct to standard discharge education. Patients felt more confident and informed on discharge about the expectations of caring for their heart disease and the need for cardiac rehabilitation. Despite knowing the benefits of cardiac rehabilitation, it remained an underutilized resource for these patients.

Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study.

OBJECTIVE: The Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) study compared the effects of once-monthly paliperidone palmitate with daily oral antipsychotics on treatment failure in adults with schizophrenia. METHOD: The PRIDE study is a 15-month, randomized, multicenter study (May 5, 2010, to December 9, 2013) of adult subjects with a DSM-IV diagnosis of schizophrenia and a history of incarceration. Subjects were randomly assigned to once-monthly paliperidone palmitate injections or daily oral antipsychotics (randomly assigned from 7 acceptable, prespecified oral antipsychotics) for 15 months. The primary end point was time to first treatment failure, defined as arrest/incarceration; psychiatric hospitalization; suicide; treatment discontinuation or supplementation due to inadequate efficacy, safety, or tolerability; or increased psychiatric services to prevent hospitalization. Time to first treatment failure was determined by a blinded event-monitoring board and analyzed with the Kaplan-Meier method. RESULTS: In this study, 450 patients were randomly assigned, and 444 were included in the intent-to-treat population. Paliperidone palmitate was associated with significant delay in time to first treatment failure versus oral antipsychotics (hazard ratio, 1.43; 95% CI, 1.09-1.88; log rank P = .011). Observed treatment failure rates over 15 months were 39.8% and 53.7%, respectively. Arrest/incarceration and psychiatric hospitalization were the most common reasons for treatment failure in the paliperidone palmitate and oral antipsychotic groups (21.2% vs 29.4% and 8.0% vs 11.9%, respectively). The 5 most common treatment-emergent adverse events for the paliperidone palmitate treatment group were injection site pain (18.6% of subjects), insomnia (16.8%), weight increased (11.9%), akathisia (11.1%), and anxiety (10.6%). CONCLUSIONS: In a trial designed to reflect real-world management of schizophrenia, once-monthly paliperidone palmitate demonstrated superiority compared to oral antipsychotics in delaying time to treatment failure. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01157351.

Cleaning of filtering facepiece respirators contaminated with mucin and Staphylococcus aureus.

BACKGROUND: Decontamination, cleaning, and reuse of filtering facepiece respirators (FFRs) has been proposed to mitigate an acute FFR shortage during a public health emergency. Our study evaluates the ability of commercially available wipe products to clean FFRs contaminated with either infectious or noninfectious aerosols. METHODS: Three models of surgical N95 FFRs were contaminated with aerosols of mucin or viable Staphylococcus aureus then cleaned with hypochlorite, benzalkonium chloride, or nonantimicrobial wipes. After cleaning, FFRs were separated into components (nose pad, fabrics, and perforated strip), and contaminants were extracted and quantified. Filtration performance was assessed for cleaned FFRs. RESULTS: Mucin removal was <1 log for all wipe products on all components. Inert wipes achieved ∼1-log attenuation in viable S aureus on fabrics from all FFR models--removal was less effective from nose pads and perforated edges. Both antimicrobial wipes achieved 3-5-log attenuation on most components, with smaller reductions on nose pads and greater reductions on perforated strips. Particle penetration following cleaning yielded mean values <5%. The highest penetrations were observed in FFRs cleaned with benzalkonium chloride wipes. CONCLUSIONS: FFRs can be disinfected using antimicrobial wipe products, but not effectively cleaned with the wipes evaluated in this study. This study provides informative data for the development of better FFRs and applicable cleaning products.

Challenge of N95 filtering facepiece respirators with viable H1N1 influenza aerosols.

OBJECTIVE. Specification of appropriate personal protective equipment for respiratory protection against influenza is somewhat controversial. In a clinical environment, N95 filtering facepiece respirators (FFRs) are often recommended for respiratory protection against infectious aerosols. This study evaluates the ability of N95 FFRs to capture viable H1N1 influenza aerosols. METHODs. Five N95 FFR models were challenged with aerosolized viable H1N1 influenza and inert polystyrene latex particles at continuous flow rates of 85 and 170 liters per minute. Virus was assayed using Madin-Darby canine kidney cells to determine the median tissue culture infective dose (TCID50). Aerosols were generated using a Collison nebulizer containing H1N1 influenza virus at 1 x 10(8) TCID50/mL. To determine filtration efficiency, viable sampling was performed upstream and downstream of the FFR. RESULTS. N95 FFRs filtered 0.8-µm particles of both H1N1 influenza and inert origins with more than 95% efficiency. With the exception of 1 model, no statistically significant difference in filtration performance was observed between influenza and inert particles of similar size. Although statistically significant differences were observed for 2 models when comparing the 2 flow rates, the differences have no significance to protection. CONCLUSIONS. This study empirically demonstrates that a National Institute for Occupational Safety and Health-approved N95 FFR captures viable H1N1 influenza aerosols as well as or better than its N95 rating, suggesting that a properly fitted FFR reduces inhalation exposure to airborne influenza virus. This study also provides evidence that filtration efficiency is based primarily on particle size rather than the nature of the particle's origin.

A pandemic influenza preparedness study: use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets.

BACKGROUND: A major concern among health care experts is a projected shortage of N95 filtering facepiece respirators (FFRs) during an influenza pandemic. One option for mitigating an FFR shortage is to decontaminate and reuse the devices. Many parameters, including biocidal efficacy, filtration performance, pressure drop, fit, and residual toxicity, must be evaluated to verify the effectiveness of this strategy. The focus of this research effort was on evaluating the ability of microwave-generated steam, warm moist heat, and ultraviolet germicidal irradiation at 254 nm to decontaminate H1N1 influenza virus. METHODS: Six commercially available FFR models were contaminated with H1N1 influenza virus as aerosols or droplets that are representative of human respiratory secretions. A subset of the FFRs was treated with the aforementioned decontamination technologies, whereas the remaining FFRs were used to evaluate the H1N1 challenge applied to the devices. RESULTS: All 3 decontamination technologies provided >4-log reduction of viable H1N1 virus. In 93% of our experiments, the virus was reduced to levels below the limit of detection of the method used. CONCLUSIONS: These data are encouraging and may contribute to the evolution of effective strategies for the decontamination and reuse of FFRs.

Optimizing use of assisted reproduction.

Infertile couples who have failed to achieve pregnancy now have new options that have become available in the last two decades. The costs are generally large and frequently not covered by insurance. Risks include multiple pregnancy and hyperstimulation syndrome. Evidence concerning results of several treatment options is presented. The large difference in success between age groups is displayed. Results to be expected from donor eggs to overcome the low success in older age groups (>38 years) are presented.