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The parallel-group randomized controlled trial was conducted in a single Australian public pediatric/obstetric hospital. The study enrolled 600 children and adolescents ages 6 months to 18 years with SRMCs who had an outpatient appointment scheduled during the 2021 Australian seasonal influenza season (from April to August). The patients were randomly assigned to a control group (n = 302; mean age, 11.4 years; 51.3% female) or to the SMS reminder text group (n = 298; mean age, 11.5 years; 54.4% female). The study examined Flutext-40, a nudge intervention, which included a parent-level nudge, in which an SMS text reminder was sent to the patient's primary caregiver. Clinician-level nudges were incorporated into standard practice at the facility and included prompt/reminder stickers and bookmarks placed in the medical record at relevant sites to facilitate vaccine recommendations. These, together with influenza vaccine signage placed around the facility and ensuring ease of access to the vaccine, made up the control intervention. In the SMS reminder arm, those randomized received all the control nudges and in addition had the parent-level nudge added. SMS text reminders were sent using a nondirective educational approach, advising that the child was eligible for a funded vaccine and could receive it at the hospital clinic or in the child's doctor's office. The reminder texts were timed to be sent before and after the child's scheduled specialist appointments during the study period, up to a maximum of three reminders. The SMS reminder intervention ceased if the parent replied that the child had been immunized. At trial conclusion, all participants received a text message with a link to a survey.

The influenza vaccination rates increased from 26.2% (n = 79) in the control group to 38.6% (n = 113) with the addition of the SMS reminder (adjusted odds ratio, 1.79). The time to receipt of immunization was significantly shorter among the SMS reminder group (adjusted hazard ratio, 1.67). In the subgroup enrolled before June 15, a significantly greater proportion of patients in the SMS reminder group were vaccinated during the optimal delivery period for influenza vaccine (April to June 30); 40% of patients in this subgroup who received the SMS reminder (n = 50/197) were vaccinated at that time, compared to 25.4% of those in the control group (n = 50/197); adjusted odds ratio, 1.97. This is an important finding given the critical importance of timely immunization for this group. The parent acceptability survey offered at trial completion was completed by 40.3% of participants (n = 242/600); children of those who responded to the survey were more likely to have received the vaccine compared to overall trial participants (43.8%; n = 106/242 vs. 32.7%; n = 192/595).

Studies have shown that children are more likely to receive the vaccine if parents remember receiving a recommendation from their child's specialist, but less than 58% of parents recall receiving such a recommendation. This intervention can alleviate that barrier. (Tuckerman, J., et al. (2023). Short message service reminder nudge for parents and influenza vaccination uptake in children and adolescents with special risk medical conditions: The Flutext-4U randomized clinical trial. JAMA Pediat, 177(4), 337-344.
Retrieved May 2023 from https://jamanetwork.com/journals/jamapediatrics/fullarticle/2801662)

Released: May 2023

Nursing Drug Handbook

© 2023 Wolters Kluwer

Analysis of two multicenter observational studies assessing the long-term safety and effectiveness of GH therapy: the ANSWER Program (American Norditropin Studies: Web-Enrolled Research), conducted in 202 U.S. sites from 2002 to 2016, and NordiNet International Outcome Study, conducted in 469 European sites from 2006 to 2016, pooled data from children born SGA. The analysis assessed the impact of patient age at GH initiation on long-term growth outcomes in children SGA, through measures of height standard deviation score (HSDS), target height-adjusted HSDS, and ratio of bone age to chronological age (BA/CA ratio). Patients were categorized in three groups based on age at initiation of GH therapy (age 2 to less than 4 years, age 4 to less than 6 years, and age 6 and older). The effectiveness analysis included 3,318 patients who were treatment-naïve and were prepubertal at GH therapy initiation; 356 (10.7%) were age 2 to less than 4 years at initiation, 1,048 (31.6%) were age 4 to less than 6 years at initiation, and 1,914 (57.7%) were at least 6 years old at initiation.

At GH therapy initiation, the mean HSDS was ~3.3 in the youngest group, ~3.1 in the middle group, and ~2.8 in the oldest group. After 4 years of GH therapy, mean HSDS were ~1.6 in the youngest, ~1.5 in the middle, and ~1.6 in the oldest group; after 8 years, mean HSDS were ~0.9 in the youngest, ~1.1 in the middle, and ~1.4 in the oldest group. The mean improvement in HSDS was significantly greater in the youngest group versus the oldest group both after 4 years of therapy (+1.73 versus +1.3) and after 8 years (+2.5 versus +1.7) and was significantly greater in the youngest group versus the middle group after 8 years (+2.5 versus +2.2). The mean improvement in the HSDS was also significantly greater in the middle group versus the oldest group both after 4 years (+1.6 versus +1.3) and after 8 years (+2.2 versus +1.7). No significant differences were seen in the BA/CA ratio between groups at 4 years (0.93 in youngest, 0.94 in middle, and 0.95 in oldest) and at 8 years (1.02 in youngest, 1.01 in middle, and 0.98 in oldest).

Results demonstrate that younger age at start of treatment is associated with greater improvements in growth over the 8 years compared with other patients. It's also possible that the full benefits of early treatment initiation are still to be seen as the children in that youngest age group have the potential to continue growing. A longer follow-up period might demonstrate continued optimization of adult height. (Juul, A., et al. (2023). Early growth hormone initiation leads to favorable long-term growth outcomes in children born small for gestational age.J Clin Endocrinol Metab 108 (5),1043-1052. Retrieved May 2023 from https://academic.oup.com/jcem/article/108/5/1043/6873901)

Released: May 2023

Nursing Drug Handbook

© 2023 Wolters Kluwer

A single-center study compared the impact of sacubitril-valsartan use on echocardiographic parameters, arrhythmias, atrial fibrillation, and congestion rate in patients with HFrEF over 24-month follow-up and analyzed those findings according to whether the patients had diabetes. The study enrolled 240 consecutive patients with HFrEF who were treated with sacubitril-valsartan from 2016 to 2020; 87 patients had concomitant diabetes (median age, 68 years) and 153 didn't have diabetes (median age, 66 years). At baseline, patients with diabetes were more likely to also have arterial hypertension (87% versus 64%) and coronary artery disease (74% versus 60%).

Over 24-month follow-up, improvement was seen on several parameters; in general, there were significant differences between patients with HFrEF and diabetes and those without concomitant diabetes. Median left ventricular ejection fraction (LVEF) increased significantly in patients without diabetes (from 27% interquartile range [IQR] to 35% IQR), but not in patients with diabetes (from 29% to 30% IQR). Systolic pulmonary artery pressure decreased in both groups, from 30 mm Hg to 25 mm Hg in patients without diabetes and from 34 mm Hg to 25 mm Hg in patients with diabetes, but there was no significant difference between the two groups.

Median NT-brain natriuretic peptide (NT-proBNP) levels decreased significantly in patients without diabetes (from 1,445 pg/mL IQR to 491 pg/mL IQR) but not in patients with diabetes (from 1,395 pg/mL IQR to 885 pg/mL IQR). Median troponin-1 levels decreased significantly in patients without diabetes (from 0.099 ng/mL IQR to 0.023 ng/mL IQR) but not in patients with diabetes (from 0.05 ng/mL IQR to 0.02 ng/mL IQR). No significant differences were seen in other laboratory parameters, such as GFR, creatinine levels, and potassium levels.

Measures on echocardiography didn't differ much except for the tricuspid annular plane systolic excursion, which was significantly increased in patients without diabetes (from 17 mm IQR to 18 mm IQR) and not in patients with diabetes (from 17.5 mm IQR to 18 mm IQR). Similar rates of ventricular tachyarrhythmias were observed in both groups, but the congestion rate decreased significantly in both groups, decreasing from 44.4% before sacubitril-valsartan treatment to 13.5% after 24 months in patients with diabetes and from 28.4% before treatment to 8.4% after 24 months in patients without diabetes.

The all-cause mortality rate was higher in patients with diabetes compared to those without concomitant diabetes (25% versus 8.1%). But even this mortality rate reflects an improvement over that found in published data in patients with HFrEF and diabetes not treated with sacubitril-valsartan. The study illustrates the more complicated course of HFrEF with concomitant diabetes but demonstrates that sacubitril-valsartan is still effective in these patients. (El-Battrawy, I., et al. (2023). The impact of sacubitril/valsartan on outcome in patients suffering from heart failure with a concomitant diabetes mellitus. ESC Heart Failure, 10, 943-954. Retrieved May 2023 from https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.14239)

Released: May 2023

Nursing Drug Handbook

© 2023 Wolters Kluwer