BACKGROUND: Pneumonia remains an important public health problem among elderly nursing home residents. This clinical trial sought to determine if a multicomponent intervention protocol, including manual tooth/gum brushing plus 0.12% chlorhexidine oral rinse, twice per day, plus upright positioning during feeding, could reduce the incidence of radiographically documented pneumonia among nursing home residents, compared with usual care. METHODS: This cluster-randomized clinical trial was conducted in 36 nursing homes in Connecticut. Eligible residents >65 years with at least 1 of 2 modifiable risk factors for pneumonia (ie, impaired oral hygiene, swallowing difficulty) were enrolled. Nursing homes were randomized to the multicomponent intervention protocol or usual care. Participants were followed for up to 2.5 years for development of the primary outcome, a radiographically documented pneumonia, and secondary outcome, a lower respiratory tract infection (LRTI) without radiographic documentation. RESULTS: A total of 834 participants were enrolled: 434 to intervention and 400 to usual care. The trial was terminated for futility. The number of participants in the intervention vs control arms with first pneumonia was 119 (27.4%) vs 94 (23.5%), respectively, and with first LRTI, 125 (28.8%) vs 100 (25.0%), respectively. In a multivariable Cox regression model, the hazard ratio in the intervention vs control arms, respectively, was 1.12 (95% confidence interval [CI], .84-1.50; P = .44) for first pneumonia and 1.07 (95% CI, .79-1.46, P = .65) for first LRTI. CONCLUSIONS: The multicomponent intervention protocol did not significantly reduce the incidence of first radiographically confirmed pneumonia or LRTI compared with usual care in nursing home residents. CLINICAL TRIALS REGISTRATION: NCT00975780.
RCT Entities:
BACKGROUND:Pneumonia remains an important public health problem among elderly nursing home residents. This clinical trial sought to determine if a multicomponent intervention protocol, including manual tooth/gum brushing plus 0.12% chlorhexidine oral rinse, twice per day, plus upright positioning during feeding, could reduce the incidence of radiographically documented pneumonia among nursing home residents, compared with usual care. METHODS: This cluster-randomized clinical trial was conducted in 36 nursing homes in Connecticut. Eligible residents >65 years with at least 1 of 2 modifiable risk factors for pneumonia (ie, impaired oral hygiene, swallowing difficulty) were enrolled. Nursing homes were randomized to the multicomponent intervention protocol or usual care. Participants were followed for up to 2.5 years for development of the primary outcome, a radiographically documented pneumonia, and secondary outcome, a lower respiratory tract infection (LRTI) without radiographic documentation. RESULTS: A total of 834 participants were enrolled: 434 to intervention and 400 to usual care. The trial was terminated for futility. The number of participants in the intervention vs control arms with first pneumonia was 119 (27.4%) vs 94 (23.5%), respectively, and with first LRTI, 125 (28.8%) vs 100 (25.0%), respectively. In a multivariable Cox regression model, the hazard ratio in the intervention vs control arms, respectively, was 1.12 (95% confidence interval [CI], .84-1.50; P = .44) for first pneumonia and 1.07 (95% CI, .79-1.46, P = .65) for first LRTI. CONCLUSIONS: The multicomponent intervention protocol did not significantly reduce the incidence of first radiographically confirmed pneumonia or LRTI compared with usual care in nursing home residents. CLINICAL TRIALS REGISTRATION: NCT00975780.
Authors: Marcus J Claesson; Ian B Jeffery; Susana Conde; Susan E Power; Eibhlís M O'Connor; Siobhán Cusack; Hugh M B Harris; Mairead Coakley; Bhuvaneswari Lakshminarayanan; Orla O'Sullivan; Gerald F Fitzgerald; Jennifer Deane; Michael O'Connor; Norma Harnedy; Kieran O'Connor; Denis O'Mahony; Douwe van Sinderen; Martina Wallace; Lorraine Brennan; Catherine Stanton; Julian R Marchesi; Anthony P Fitzgerald; Fergus Shanahan; Colin Hill; R Paul Ross; Paul W O'Toole Journal: Nature Date: 2012-08-09 Impact factor: 49.962
Authors: Marie R Griffin; Yuwei Zhu; Matthew R Moore; Cynthia G Whitney; Carlos G Grijalva Journal: N Engl J Med Date: 2013-07-11 Impact factor: 91.245
Authors: Michael Klompas; Kathleen Speck; Michael D Howell; Linda R Greene; Sean M Berenholtz Journal: JAMA Intern Med Date: 2014-05 Impact factor: 21.873
Authors: R Peto; M C Pike; P Armitage; N E Breslow; D R Cox; S V Howard; N Mantel; K McPherson; J Peto; P G Smith Journal: Br J Cancer Date: 1976-12 Impact factor: 7.640
Authors: Arti Hurria; Kevin P High; Lona Mody; Frances McFarland Horne; Marcus Escobedo; Jeffrey Halter; William Hazzard; Kenneth Schmader; Heidi Klepin; Sei Lee; Una E Makris; Michael W Rich; Stephanie Rogers; Jocelyn Wiggins; Rachael Watman; Jennifer Choi; Nancy Lundebjerg; Susan Zieman Journal: J Am Geriatr Soc Date: 2017-01-16 Impact factor: 5.562
Authors: Robin L P Jump; Christopher J Crnich; Lona Mody; Suzanne F Bradley; Lindsay E Nicolle; Thomas T Yoshikawa Journal: J Am Geriatr Soc Date: 2018-04 Impact factor: 5.562
Authors: Manisha Juthani-Mehta; Peter H Van Ness; Luann Bianco; Andrea Rink; Sabina Rubeck; Sandra Ginter; Stephanie Argraves; Peter Charpentier; Denise Acampora; Mark Trentalange; Vincent Quagliarello; Peter Peduzzi Journal: JAMA Date: 2016-11-08 Impact factor: 56.272
Authors: Mary Lyons; Craig Smith; Elizabeth Boaden; Marian C Brady; Paul Brocklehurst; Hazel Dickinson; Shaheen Hamdy; Susan Higham; Peter Langhorne; Catherine Lightbody; Giles McCracken; Antonieta Medina-Lara; Lise Sproson; Angus Walls; Dame Caroline Watkins Journal: Eur Stroke J Date: 2018-05-08
Authors: Vanessa R Y Hollaar; Gert-Jan van der Putten; Claar D van der Maarel-Wierink; Ewald M Bronkhorst; Bert J M de Swart; Nico H J Creugers Journal: BMC Geriatr Date: 2017-06-19 Impact factor: 3.921
Authors: David A Richards; Angelique Hilli; Claire Pentecost; Victoria A Goodwin; Julia Frost Journal: J Clin Nurs Date: 2018-01-10 Impact factor: 3.036