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Abstract Introduction Pediatric positive airway pressure (PAP) therapy can be challenging for children and their parent/guardian (PG). These challenges are complicated by the need to facilitate behavioral competency in the management of both device equipment and therapy. Methods As part of a larger quality management project aimed to improve PG and patient satisfaction we developed a targeted education visit provided by registered nurses prior to PAP trial initiation. Principle aims were to measure satisfaction with education and increase PG confidence in ability to manage therapy. The nurse session included: education on Obstructive Sleep Apnea (OSA) and PAP therapy, development of plan for first month of therapy, concepts of desensitization, regular practice, discussion and identification of concerns (assessment of barriers to implementation). A survey was administered pre-intervention to assess PG confidence in ability to manage therapy. Post-intervention, PG rated the interventions impact on baseline confidence, as well as an assessment of satisfaction with the education and content. Descriptive statistics were utilized to summarize the Likert survey questions. Results A total of 21of 25 (84%) participants completed surveys. 100% of PG that responded was either extremely satisfied or very satisfied with the educational intervention. Prior to the intervention, 19% (N4) indicated little to no confidence, 19% (N4) indicated some confidence and 62% (N13) indicated being very confident. 62% (N13) of PG’s indicated the information covered was new to them, while 24% (N5) indicated some information was new and 14% (N3) indicated none of the information was new. Regardless of baseline confidence, 100% (N21) responded that the intervention further improved confidence to a great degree. Conclusion The nurse visit resulted in high satisfaction with care and education and impacted PG confidence in ability to implement treatment. Future studies are needed to determine the impact on patient compliance. Support

Objective Over half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty. Design We searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and Clinicaltrials.gov through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy of licenced pharmacological therapies (alosetron, eluxadoline, ramosetron and rifaximin) in adults with IBS-D or IBS-M. Trials included in the analysis reported a dichotomous assessment of overall response to therapy, and data were pooled using a random effects model. Efficacy and safety of all pharmacological therapies were reported as a pooled relative risk with 95% CIs to summarise the effect of each comparison tested. Treatments were ranked according to their p score. Results We identified 18 eligible RCTs (seven alosetron, five ramosetron, two rifaximin and four eluxadoline), containing 9844 patients. All were superior to placebo for the treatment of IBS-D or IBS-M at 12 weeks, according to the Food and Drug Administration (FDA)-recommended endpoint for trials in IBS. Alosetron 1 mg twice daily was ranked first for efficacy, based on the FDA-recommended composite endpoint of improvement in both abdominal pain and stool consistency, effect on global symptoms of IBS and effect on stool consistency. Ramosetron 2.5µg once daily was ranked first for effect on abdominal pain. Total numbers of adverse events were significantly greater with alosetron 1 mg twice daily and ramosetron 2.5µg once daily, compared with placebo. Rifaximin 550 mg three times daily ranked first for safety. Constipation was significantly more common with all drugs, except rifaximin 550 mg three times daily. Conclusion In a network meta-analysis of RCTs of pharmacological therapies for IBS-D and IBS-M, we found all drugs to be superior to placebo, but alosetron and ramosetron appeared to be the most effective.

Background— Despite its salutary effects on health, aerobic exercise is often avoided after receipt of an implantable cardioverter defibrillator (ICD) because of fears that exercise may provoke acute arrhythmias. We prospectively evaluated the effects of a home aerobic exercise training and maintenance program (EX) on aerobic performance, ICD shocks, and hospitalizations exclusively in ICD recipients. Methods and Results— A total of 160 patients (124 men and 36 women) were randomly assigned who had an ICD for primary (43%) or secondary (57%) prevention to EX or usual care (UC). The primary outcome was peak oxygen consumption, measured with cardiopulmonary exercise testing at baseline and 8 and 24 weeks. EX consisted of 8 weeks of home walking for 1 h/d, 5 d/wk at 60% to 80% of heart rate reserve, followed by 16 weeks of maintenance home walking for 150 min/wk. Adherence to EX was determined from exercise logs, ambulatory heart rate recordings of exercise, and weekly telephone contacts. Patients assigned to UC received no exercise directives and were monitored by monthly telephone contact. Adverse events were identified by ICD interrogations, patient reports, and medical charts. ICD recipients averaged 55±12 years and mean ejection fraction of 40.6±15.7; all were taking β-blocker medications. EX significantly increased peak oxygen consumption (EX, 26.7±7.0 mL/kg per minute; UC, 23.9±6.6 mL/kg per minute; P =0.002) at 8 weeks, which persisted during maintenance exercise at 24 weeks (EX, 26.9±7.7 mL/kg per minute; UC, 23.4±6.0 mL/kg per minute; P <0.001). ICD shocks were infrequent (EX=4 versus UC=8), with no differences in hospitalizations or deaths between groups. Conclusions— Prescribed home exercise is safe and significantly improves cardiovascular performance in ICD recipients without causing shocks or hospitalizations. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00522340.