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Nurse case management did not improve MDR-TB treatment success, though treatment-failure odds were lower in secondary analysis

IJTLD open (PubMed)Jul 13, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a 10-hospital cluster-randomized trial with 2,134 analyzed patients, nurse case management did not significantly improve multidrug-resistant tuberculosis treatment success, although a secondary analysis found lower adjusted odds of treatment failure.

What NurseJet pulled from the source

This pragmatic cluster-randomized trial evaluated nurse case management for multidrug-resistant tuberculosis at 10 district hospitals in South Africa. Of 2,844 people enrolled between 2014 and 2019, 2,134 were analyzed: 1,093 in nurse case management and 1,041 in usual care. Treatment success was 64.5% with nurse case management and 61.9% with usual care, a nonsignificant difference; the adjusted primary analysis also showed no improvement. Treatment failure occurred in 2.6% and 4.5%, respectively, and a secondary adjusted analysis found 44% lower odds of treatment failure (aOR 0.56, 95% CI 0.31 to 0.99). Other outcomes did not differ significantly, and the intervention alone did not overcome loss to follow-up or delayed presentation.

Why this matters for nurses

Nurses often coordinate prolonged tuberculosis treatment, follow-up, education, and communication across care settings. This trial matters because it tests a nurse-centered delivery model at scale while showing that case management alone may not be enough to improve overall treatment success.

Bedside takeaway

Worth knowing that nurse case management alone did not improve overall MDR-TB treatment success, despite lower treatment-failure odds in a secondary analysis.

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Key takeaways

The pragmatic trial was conducted at 10 South African district hospitals and analyzed 2,134 patients.
Treatment success was 64.5% with nurse case management and 61.9% with usual care, with no significant improvement.
A secondary analysis found lower adjusted odds of treatment failure with nurse case management.
The intervention did not overcome barriers related to loss to follow-up or delayed presentation.

Practice implications

Programs using nurse case management for multidrug-resistant tuberculosis should track treatment success, failure, loss to follow-up, and delayed presentation separately. The null primary result argues for evaluating additional system and access supports rather than relying on case management alone.

Limitations & cautions

The trial involved 10 district hospitals in two South African provinces, enrollment occurred from 2014 to 2019, and 2,134 of 2,844 enrolled patients were analyzed. The primary outcome was not improved, while the lower treatment-failure estimate came from a secondary analysis with a confidence interval close to no difference.
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Citations

Exact source links

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IJTLD open (PubMed)

IJTLD open (PubMed). Nurse case management to improve multidrug-resistant TB: a cluster-randomised trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42445215/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Frontiers in cardiovascular medicine (PubMed)Jun 30, 2026Research ArticlePractice applicable

In a single-center randomized trial of 122 adults with atrial fibrillation, a nurse-led WeChat and cloud follow-up program improved early INR compliance, INR monitoring, medication adherence, and knowledge, but detected no difference in complications or readmissions.

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Research ArticleResearchMedication SafetyPatient EducationPractice applicableAI summary · original source linked below

This randomized trial enrolled 122 cardiology patients taking long-term warfarin and assigned 61 to routine discharge education or 61 to the same education plus an Internet Plus Nursing telehealth program using WeChat and cloud-based education and monitoring. At 10 days, INR compliance was 98.3% with telehealth and 86.5% with usual care; at 1 month it was 86.7% and 57.7%. INR monitoring rates were also higher at both time points. Medication adherence was 88.3% with telehealth and 48.1% with usual care, and knowledge and satisfaction scores were higher. No significant differences were detected in complications or readmissions during six months of follow-up, so the trial supports process and adherence benefits rather than improved clinical outcomes.

Key takeaways

The single-center trial randomized 122 adults taking long-term warfarin for atrial fibrillation.
The intervention combined routine education with WeChat and cloud-based nurse follow-up for six months.
INR compliance and monitoring were higher at 10 days and 1 month, and medication adherence was higher with telehealth.
The trial detected no significant difference in complications or readmissions.

Why this matters on shift

Cardiology and medication-safety nurses reinforce warfarin teaching, coordinate INR follow-up, and identify barriers after discharge. This trial matters because it tested a nurse-led digital pathway and measured both care-process outcomes and clinical outcomes instead of treating improved engagement as proof of fewer complications.

Bedside takeaway

Be aware that nurse-led warfarin telehealth improved INR follow-up and adherence, but the small trial detected no reduction in complications or readmissions.

Nursing implications

A structured, approved telehealth pathway may help reinforce INR follow-up and medication adherence after discharge. Teams should still monitor bleeding, thromboembolic events, complications, and readmissions because better process measures did not translate into detected clinical-outcome differences in this small trial.

Limitations & cautions

This was a single-center study of 122 patients in one Chinese cardiology department with six months of follow-up. The intervention combined education, WeChat contact, and cloud monitoring, and the study did not detect differences in complications or readmissions.
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Citations · exact source links

Frontiers in cardiovascular medicine (PubMed). Effect of internet plus nursing mode telehealth intervention on warfarin management in atrial fibrillation patients.

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Open original sourceFull brief

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Healthcare (Basel, Switzerland) (PubMed)Jun 23, 2026Research ArticlePractice applicable

In an eight-ward cluster-randomized crossover trial of 1,324 adults, replacing peripheral IV catheters only when clinically indicated was noninferior to routine 96-hour replacement for phlebitis and required fewer insertions with longer dwell times.

Med-SurgAI summaryReview source

Research ArticleResearchWorkflowPractice applicableAI summary · original source linked below

This noninferiority cluster-randomized crossover trial enrolled 1,324 adults who required peripheral IV therapy for at least 96 hours across eight wards of one South Korean hospital. Phlebitis occurred in 12.6% with clinically indicated replacement and 11.7% with routine 96-hour replacement. The absolute risk difference was 1.44 percentage points (95% CI -1.47 to 4.35), remaining within the prespecified 5-point noninferiority margin. Clinically indicated replacement required fewer catheter insertions per patient (mean 1.77 versus 2.16) and produced longer mean dwell times (112.0 versus 89.6 hours). No catheter-related bloodstream infections occurred in either group, but zero rare events do not establish comparative bloodstream-infection safety.

Key takeaways

The trial included 1,324 adults across eight wards in a cluster-randomized crossover design.
Clinically indicated replacement was noninferior to routine 96-hour replacement for phlebitis.
Patients in the clinically indicated group had fewer insertions and longer catheter dwell times.
No catheter-related bloodstream infections occurred, but the trial cannot establish noninferiority for this rare outcome.

Why this matters on shift

Med-Surg nurses assess peripheral IV sites, decide when findings need escalation, and perform or coordinate replacement. This trial matters because it tested whether an assessment-driven approach can avoid routine reinsertion without exceeding the prespecified phlebitis margin.

Bedside takeaway

Worth knowing that clinically indicated PIVC replacement was noninferior for phlebitis and reduced repeat insertions in an eight-ward trial.

Nursing implications

Facilities considering clinically indicated replacement can use these findings alongside a standardized catheter-assessment, documentation, and escalation pathway. Individual nurses should not extend dwell time outside an approved protocol, and bloodstream-infection surveillance remains necessary despite zero events in this study.

Limitations & cautions

The study was conducted in 2021 at one South Korean tertiary hospital across eight wards and included adults expected to need peripheral IV therapy for at least 96 hours. Zero catheter-related bloodstream infections in both groups cannot establish comparative safety for that rare outcome.
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Citations · exact source links

Healthcare (Basel, Switzerland) (PubMed). Routine Versus Clinically Indicated Replacement of Peripheral Intravenous Catheters in Adults: A Non-Inferiority Cluster-Randomised Crossover Trial.

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Open original sourceFull brief

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European Journal of Clinical Pharmacology (PubMed)Jul 10, 2026Systematic Review

Across 12 studies, pooled hemoglobin and ferritin were higher with intravenous ferric carboxymaltose than oral iron during pregnancy, with the clearest hemoglobin difference before delivery, but substantial between-study heterogeneity limits certainty.

L&D / OB Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyPatient EducationAI summary · original source linked below

This systematic review and meta-analysis pooled eight randomized trials and four observational cohorts comparing intravenous ferric carboxymaltose with oral iron for anemia during pregnancy. In the hemoglobin analysis, seven trials and four cohorts included 6,495 patients. Intravenous treatment was associated with hemoglobin that was 0.91 g/dL higher (95% CI 0.30 to 1.51) and ferritin that was 63.8 ng/mL higher (95% CI 37.3 to 90.4). The hemoglobin difference was clearest before delivery, at 1.22 g/dL across eight studies with 1,575 patients, but was not significant postpartum. In smaller safety analyses, intravenous ferric carboxymaltose was associated with fewer drug-related adverse events (RR 0.42) and less nausea (RR 0.27) than oral iron. The authors judged it more effective for hematologic indices and favorably tolerated, while cautioning that substantial heterogeneity across studies limits confidence and does not define the best route for every patient.

Key takeaways

The review included 12 studies: eight randomized trials and four observational cohorts of pregnant patients with anemia.
Pooled hemoglobin was 0.91 g/dL higher with intravenous ferric carboxymaltose than with oral iron.
The predelivery hemoglobin difference was 1.22 g/dL, while the postpartum difference was not statistically significant.
Smaller safety analyses found fewer drug-related adverse events and less nausea, but heterogeneity remained substantial.

Why this matters on shift

Anemia treatment during pregnancy often requires balancing time to delivery, response to oral therapy, infusion logistics, and medication tolerance. This review matters for obstetric nurses because it quantifies the hematologic difference between routes while making clear that pooled evidence does not determine treatment for an individual patient.

Bedside takeaway

Be aware that pooled predelivery hemoglobin was higher with IV ferric carboxymaltose than oral iron, but heterogeneity and limited safety subsets mean route selection remains individualized.

Nursing implications

For obstetric nurses, the findings support awareness that prescribed intravenous iron was associated with higher predelivery hemoglobin while requiring infusion-specific screening, administration, and observation under local policy. They do not establish that intravenous treatment is appropriate for every patient or replace prescriber-directed selection and follow-up.

Limitations & cautions

The review combined randomized trials with observational cohorts, and substantial heterogeneity existed across studies. Safety estimates came from smaller subsets, the postpartum hemoglobin difference was not significant, and the abstract does not establish comparative effects on transfusion, birth outcomes, maternal symptoms, or longer-term infant outcomes.
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Citations · exact source links

European Journal of Clinical Pharmacology (PubMed). Efficacy and safety of intravenous ferric carboxymaltose versus oral iron in pregnant women with anemia: a systematic review and meta-analysis.

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Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Nurse-led warfarin telehealth improved early INR measures and medication adherence, but complication and readmission rates did not differ significantly

Clinically indicated PIVC replacement was noninferior for phlebitis and required fewer insertions than 96-hour replacement

Predelivery hemoglobin was higher with IV ferric carboxymaltose than oral iron in a pregnancy anemia meta-analysis