Rationale and design of a randomized trial of automated hovering for post-myocardial infarction patients: The HeartStrong program.

BACKGROUND: Coronary artery disease is the single leading cause of death in the United States, and medications can significantly reduce the rate of repeat cardiovascular events and treatment procedures. Adherence to these medications, however, is very low. METHODS: HeartStrong is a national randomized trial offering 3 innovations. First, the intervention is built on concepts from behavioral economics that we expect to enhance its effectiveness. Second, the implementation of the trial takes advantage of new technology, including wireless pill bottles and remote feedback, to substantially automate procedures. Third, the trial's design includes an enhancement of the standard randomized clinical trial that allows rapid-cycle innovation and ongoing program enhancement. RESULTS: Using a system involving direct data feeds from 6 insurance partners followed by mail, telephone, and email contact, we enrolled 1,509 patients discharged from the hospital with acute myocardial infarction in a 2:1 ratio of intervention:usual care. The intervention period lasts 1 year; the primary outcome is time to first fatal or nonfatal acute vascular event or revascularization, including acute myocardial infarction, unstable angina, stroke, acute coronary syndrome admission, or death. CONCLUSIONS: Our randomized controlled trial of the HeartStrong program will provide an evaluation of a state-of-the-art behavioral economic intervention with a number of important pragmatic features. These include a tailored intervention responding to patient activity, streamlining of consent and implementation processes using new technologies, outcomes centrally important to patients, and the ability to implement rapid-cycle innovation.

Preventing the Spread of Pertussis in Pediatric Healthcare Settings.

The surge in pertussis incidence in recent years underscores a critical need for effective plans to prevent transmission in pediatric healthcare settings. Adolescents and adults are common sources of infection for unimmunized or incompletely immunized infants and children with waning immunity. Despite documented outbreaks being limited in size, pertussis poses a threat to pediatric healthcare facilities due to the risk for widespread transmission, potentially severe complications among vulnerable patient populations, and high outbreak control-related costs. Healthcare personnel, visitors, and parents have been identified as sources of outbreaks, underscoring the importance of coordinated efforts to prevent transmission in these settings. This comprehensive review demonstrates that the risk of pertussis transmission in pediatric healthcare settings warrants heightened focus on strategies to recognize disease earlier, improve diagnostic evaluation, and facilitate effective contact tracing and post-exposure prophylaxis measures. This review suggests that healthcare personnel can play a significant role in the prevention of healthcare-associated pertussis.