bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient satisfaction with an advanced nurse practitioner (ANP) integrated community chest pain clinic
Authors: Ingram S , O'sullivan K , O'donnell S
Published: July 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Martha McMenamin Scholarship, small grant awarded

Background

Patient presentations with chest pain to the Emergency Department (ED) account for 9% of ED attendances. In the primary care setting chest pain is a common presenting complaint with an over diagnosis/suspicion of stable angina, however General Practitioners (GPs) lack access to a cardiac specialist in a timely fashion. As a result 31% of all ED chest pain patients are referred by GPs. The innovative integrated community chest pain clinic (ICCPC) commenced in September 2020. This Advanced Nurse Practitioner (ANP) led clinic aims to provide an alternative avenue to which GPs can directly refer patients with non-acute chest pain, thereby shifting the focus of care from the acute hospital environment

Purpose

Integrated community based care and ANP led care are new phenomena to the Irish patient. This paper explores patient satisfaction with the ANP led integrated community chest pain clinic

Method

This quantitative descriptive study invited participation from ICCPC patients over a six-month period (N=177). The questionnaire was adapted from Cross et al, (2010). Return of the anonymous questionnaire was by freepost/Qualtrics. Ratings were based on a five-point scale from ‘Poor’ to ‘Excellent’. Satisfaction and experience of ANP led community care was evaluated and satisfaction with appointment scheduling, waiting times, service provision and follow-up care was measured. Quantitative data were analysed using descriptive statistics. A combination of ‘good’ very good’ and ‘excellent’ are taken to mean a positive rating. Ethical approval was granted by the hospital ethics committee.

Results

A response rate of 43.5% (n=77) was achieved, including female (55.2%) white Irish (85.1%) and age range 50–69 yrs (53%). Confidence in the level of assessment by the ANP received a 100% (n=77) positive rating. All responders felt safe in the clinic 100% (n=74). Appointment waiting times received positive ratings: GP to ICCPC waiting times 98% (74/75); referral from ICCPC to hospital for stress test 92% (35/38); and 94.3% (50/53) positive rating regarding waiting times for phone-reported test results. Suggestions for improvements included the need for clearer signage/easier access to the ICCPC and a preference for follow-up check-ups by the ICCPC. If discharged for hospital follow up some wished for clearer follow-on care plans from the hospital.

Conclusion and Implications

This study suggests that the ANP led integrated community chest pain clinic plays a crucial role in meeting the needs of integrated patient centred care. The ANP led clinic was well received by patients and is a blueprint for other community initiatives. Many positive comments were included, with one participant stating "this service should be in every community, I think this would encourage people to go to the GP about mild chest pain without the fear of being sent to ED".
Improving the quality of life an empowerment of our patients with ischemic heart disease
Authors: Gonzalez Batista B , Marti Bertomeu F , Clemente Prat A , Corzan Melgosa P , Esclusa Serra M , Santaularia Capdevila N , Pintado Pallares L , Vazquez Oliva G
Published: July 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Fundació Althaia

It is proved that nursing interventions in chronic coronary heart illnesses decrease mortality and risk of a new coronary event. This is achieved through the development and performance of a personalized educational plan, focused on health promotion, aimed at modifying or enhancing a heart-healthy lifestyle and facilitating strategies to promote patient's empowerment, helping them assume certain responsibility in their own heart-healthy. Always based on humanized and empathetic care. This individual attention is reinforced with a "Health School" which is a group of talks addressed to patients and their close family members. Since 2019 we organizer two to healthy walks a year. Once the program is completed are referred to the Primary Care nursing.

Objectives

Improving the knowledge's level of patients with regards to their illness and its treatment. The keys consist in designing easy strategies for an optimum self-control of the illness. Evaluate the acquired knowledge and recording level of satisfaction with the program.

Methodology

A descriptive and retrospective study of patients with ischemic heart disease the for 5 years, from 2015 to 2020. After the hospital discharge, an outpatient nursing follow-up is performed on a 1, 3 and 6 months basis finalizing whit a group talk a kind of "School of health", carried out 3 times a year in 3 educational sessions.

Results

Among 960 patients monitored: 852 who successfully completed, 97 abandoned the program before having completed it and 11 who unfortunately died.

The variables studied in the educational plan are: Identifies cardiovascular risk factors and knows how to act tochange them (82.5%) Recognizes signs and symptoms of chest pain and how to act (90.9%) Recognizes their responsibility for monitoring of the prescribed treatment (91.2%).

In relation to the "School of health" 334 patients attended 156 companions, of the topics covered: the most important was the psychological / emotional aspect followed by control of risk factors and exercise, the information on the pathology and finally diet and sexuality.

Innovative contribution to policy, practice and/or research

The nursing interventions carried out with Educational Program hare proved on patients knowledge improvement and a higher adherence to treatment as well as a major self control of risk factors. Patients and their families report a high level of satisfaction with the program. Under our opinion all this will have a positive impact in the future an impact in the future improving the quality of life of patients and their closest families, reducing the possibilities of new coronary events decreasing as well health care costs for the society. It will more over guaranties a good continuity between specialized and primary care nursing.
The prevalence of negative attitudes towards nurses and depressive symptoms in nurses working in cardiology departments in Malopolska region, preliminary results.
Authors: Wolfshaut-Wolak R , Nowacka A , Micek A , Wadas T , Gniadek A
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

A significant increase in negative attitudes towards nurses accompanied by exacerbation of depressive symptoms in nurses working in cardiology departments have been observed.

Objective

The assessment of the intensity of negative attitudes towards nurses and depressive symptoms experienced by nurses working in cardiology departments in Malopolska region.

Methods

A cross-sectional study was conducted between 2020 and 2022. It was carried out in a group of 130 nurses working in conservative cardiology departments and 72 nurses working in interventional cardiology departments. The nurses were randomly selected from the register of hospital employed nurses of Malopolska Regional Chamber of Nurses and Midwives. The incidence and intensity of negative experiences at work were determined based on NAQ (The Negative Acts Questionnaire) and the incidence and intensity of depressive symptoms were measured by means of Beck’s depression scale.

Results

Among all the nurses surveyed 58% of them experienced some negative attitudes and the exacerbation of mild, moderate and severe depressive symptoms was observed in 37.1%, 18.3% and 4.5% of respondents respectively; no significant differences were found between conservative cardiology departments and interventional cardiology departments. A positive correlation was observed between the exacerbation of depressive symptoms and negative attitudes towards nurses r=0.335, p<0.001, and this correlation was stronger in interventional cardiology departments r=0.397, p<0.001. The risk of developing depressive symptoms was 3.4 times higher in nurses exposed to negative attitudes than in those who did not experience such behaviours (95% CI: 1.61-7.62).

Conclusions

The results of this study show that nurses working in cardiology departments in Malopolska region are exposed to negative attitudes and suffer from exacerbated depressive symptoms, which might affect the quality of the patient care they provide.
First CARMAT implantation in Italy: A Nurse's Experience
Authors: Pettillo V
Published: July 2022

Funding Acknowledgements

Type of funding sources: None. Main funding source(s): Anyone

Introduction

CARMAT is a new fully implantable device that simulates heart function. CARMAT has three characteristics that allow a physiological simulation that is at the top of biomedical engineering: it is blood-compatible for the use of bovine pericardium; it is pulsatile because it has hydraulic pumps that mimic systole and diastole; it is capable of self-regulating with the physiological needs of the patient. CARMAT has four biological valves that allow the intake of acetylsalicylic acid avoiding the use of warfarin and continuous blood draw. CARMAT also has two hybrid membranes with an internal part formed by bovine pericardium and an external polyurethane membrane; CARMAT has self-regulation sensors that adapt the system to the patient's efforts. The operation is relatively simple because the rollers placed inside move the silicondressingstely and so it pushes the walls creating systole and diastole not synchronously as it normally happens but asynchronously, one ventricle at a time.

Objectives

Evaluation of the patient's hemodynamics, monitoring of vital parameters, dressings of the drive-line and psychological state.

Materials and methods

Training in the field by the manufacturer due to the absence of material in literature.

Outcome and Discussion

Since it was the first CARMAT implantation in Italy , we tried to combine experience with the clinical practice of other artificial hearts. The patient was weaned from anesthesia early and extubated; the patient did not show neurological damage. Psychologically, the artificial heart was accepted without any problems by the patient, the drive line had no infections and the patient was discharged quickly.

Conclusions

The Carmat system appears to be the one that best simulates the physiology of the heart because it involves fewer complications than other artificial hearts. This device is used as a brige to transplant, but research and continuous studies tend to transform it as a therapy to end for patients who leave the transplant list and therefore the possibility of having a heart transplant.
Remote genetic counselling provision for heart failure patients at a UK transplant centre
Authors: Quinn E M , Mason S , Halliday B
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiomyopathy has been highlighted as one of the key drivers of heart failure, particularly dilated cardiomyopathy (DCM) (5,1). Finding the correct diagnosis for patients is not only important to their health, but to that of their family members (2).

European guidelines recommend genetic counselling and testing for all patients with a cardiomyopathy diagnosis (3). Genetic counselling involves communicating complex information and providing support to patients and families with inherited conditions. It is recommended that patients undergo genetic counselling alongside genetic testing (6).

Purpose

historically, the heart failure team had no formal pathway in place for genetic testing. We set to establish a remote provision for genetic counselling and testing. We hoped to increase access to genetic services, without additional trips to the hospital in this already burdened patient group.

Methods

A genetic counsellor (GC) attended the weekly team meeting to raise awareness of the genetic service and help identify eligible patients. Eligibility was determined using criteria from the national genomic test directory (4).

Eligible patients had appointments via video or phone call. Outpatients who consented to genetic testing had blood samples arranged locally or at an upcoming hospital appointment. Inpatients had blood samples taken during their hospital stay.

Forty-one eligible patients were identified, the majority had DCM (n=40) and one had arrhythmogenic right ventricular cardiomyopathy (ARVC). Genetic testing was performed using a diagnostic DCM or ARVC panel. Results were classified as positive, i.e. pathogenic or likely pathogenic variant identified; negative, i.e. no pathogenic variant identified; or inconclusive, i.e. variant of unknown significance identified. Results were fed back to patients by virtual genetic counselling appointment. GCs facilitated screening of family members as appropriate.

Results

In the period, July 2020 to January 2022, 41 patients attended virtual genetic counselling appointments and consented to genetic testing. Of these, 19 received a positive genetic result, 4 an inconclusive result, and 18 a negative result. The majority of positive results were identified in the TTN gene (n=9) (see Figure 1).

To date, six family members have been identified as gene positive and requiring ongoing screening, whilst six have now been discharged on the basis of a gene negative result. These are preliminary figures and expected to grow as more family members are able to access genetic counselling

Conclusion

Heart failure patients represent an underserved population who may benefit from genetic testing alongside genetic counselling. Remote genetic counselling is an effective service delivery model. A significant proportion of patients (46.3%) received a positive genetic result. This has potential benefits, not only to the patient but to family members.
Nutritional Status among patients with Heart Failure and Thyroid Diseases - Result of Nutritional Status Heart Study (NSHS)
Authors: Czapla M , Juarez-Vela R , Lokiec K , Karniej P , Smereka J , Wleklik M
Published: July 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Wroclaw Medical University

Background

Nutritional status is related to the prognosis and the length of hospitalization of individuals with heart failure. The effects of thyroid dysfunction in patients with pre-existing heart failure and nutritional status have not been adequately studied.

Purpose

This study aims to assess how nutritional status affects thyroid disease in patients with heart failure.

Methods

We performed a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of our University Clinical Hospital between September 2017 and September 2020 due to acute heart failure (HF) (ICD10: I50). We analyzed all the patients who met the inclusion criteria (diagnosis of HF, age ≥18 years old). A final group of 1056 patients’ medical records was analyzed. The analysis included data such as age, gender, patients’ body mass index (BMI), and laboratory results such as total data on past and comorbid disease units and assessment of the nutritional status of the patient via the NRS-2002. Our study was approved by the independent Bioethics Committee of the Wroclaw Medical University (decision no. KB–590/2020). Statistical analysis was performed using Statistica 13.1 (StatSoft, Inc., Tulsa, OK, USA). The results were considered statistically significant at p<0.05

Results

A total of 1056 individuals were included in the analysis. It included more men than women (66,7%) Due to a lack of data for some parameters, those numbers are smaller and are provided for each variable. More than 76% of participants were overweight or obese. 4.3% of patients were in risk of malnutrition. Thyroid disease registered in 15.1% of patients (Hyperthyroidism – 5.3% and Hypothyroidism 9.8%)

Based on BMI, four groups were distinguished: <18.5, 18.5–24.9, 25.0–29.9, and ≥30 The occurrence of Hyperthyroidism was more frequently observed in the group of overweight patients (p=0,02) (table 1).

Based on NRS2002, two groups were distinguished: <3 and ≥3. In the group with risk of malnutrition (NRS ≥3) patients had a mean statistically significant higher FT4 (<0.001) than the group with no risk of malnutrition (NRS <3) ( x̅ : 2,02 ng/dl vs x̅ : 1.35 ng/dl, p<0.001). Additionally, lower scores of FT3 were observed in the group NRS ≥3 (x̅ : 1.91 ng/dl, p<0.001) (table2).

Conclusion

This study shows that patients with thyroid disease and heart failure were often overweight and obese. The risk of malnutrition status correlates with a lower result of FT3 and the highest FT4. Undoubtedly, those phenomena require further research.
Cost-effectiveness of Internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms
Authors: Mourad G , Lundgren J , Andersson G , Husberg M , Johansson P
Published: July 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): The Swedish Research Council and the Medical Research of Southeast Sweden

Introduction

Cost-effectiveness evaluations of psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD) are rare. In a recent study we reported that a 9-week iCBT program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients.

Purpose

To evaluate the cost-effectiveness of this intervention.

Methods

Cost-effectiveness analysis of a RCT, using an incremental cost-effectiveness ratio (ICER). The costs and effects included in the ICER are from baseline to one year post intervention, but also costs for guidance and support to patients in iCBT and ODF groups. Data on healthcare costs were retrieved from healthcare registries, and the EQ-5D-3L was used to calculate the quality-adjusted life years (QALYs). The ICER can be seen as the additional costs needed to gain an additional QALY by the iCBT compared to ODF.

Results

At 12-month follow-up, the QALY was significantly higher in iCBT compared to the ODF group (0.713 vs.0.598, p=.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of one year. The ICER for iCBT versus ODF was €18,865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared to ODF.

Conclusions

The ICER of €18,865 was lower than the cost-effectiveness threshold range of €23,400-€35,100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.
Supervision by direct observation with video recording in the operating room: educational tool for learning and formative evaluation
Authors: Mleyhi S , Miri R , Daoued Z , Derbel B , Denguir R
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Directly observed supervision with video recording (DOSVR) is used as a learning method in several countries. This technique has proven itself, but remains little used in Tunisia. On the other hand, the use of DOSVR in surgery is rarely described. The objectives of our work were to describe the development and experimental implementation of DOSVR in surgery and to evaluate the feedback from residents and teachers.

Methods

This is a prospective, observational and descriptive study concerning the experimentation of DOSVR in five surgical procedures performed by residents of cardiovascular surgery department. These video recordings were followed by a backscatter with self and heteroevaluation.

We based ourselves on the methodology of teaching by simulation for the design of the protocol: the Briefing, the scenario and then the debriefing.

Results

A total of ten took part in this experiment. The average age was 28.5 years [26 -33 years] with a sex ratio F/M of 4. All residents declared that the protocol provided was easy to understand and apply. After obtaining the consent of the patients, five interventions were filmed in whom three were in emergency. Seven residents said that using a smartphone to vdeo recording was not easy and 8 easily got rid of the presence of the camera. All the learners denied having to change their operating techniques because they were being filmed. All the residents agreed that a minimum number of six DOSVR sessions in each residency year is appropriate and praised the technique as a powerful tool for the development of their practical training.

Conclusions

Our study showed that the application of Directly observed supervision with video recording in vascular surgery is feasible. It is a promising educational tool for the practical learning of residents as well as a tool for the continuous formative evaluation of their progress.
Patients experiences of using a publicly avaliable mobile health application for self-care of heart failure in a real-world setting
Authors: Madujibeya I , Chung M L , Moser D K , Miller J L , Humbert J , Chih M , Pelzel J M , Lennie T A
Published: July 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of Kentucky disseration award

Background

Publicly available patient-focused mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients’ experiences using mHealth apps for self-care in real-world settings. The purpose of this study was to explore patients’ experiences using a publicly available mHealth app, OnTrack to Health, for HF self-care in a real-world setting.

Method

Patient satisfaction, measured with a 5-point Likert scale and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients’ responses was conducted with qualitative software, Atlas. ti version 8.

Results

Patients (median age = 64.0 [57.0, 70.5] years, 73.9% (n = 17) male) used OnTrack to Health for a median duration of 164.0 [ 51.2, 639.9] days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Four themes emerged from the responses to the open-ended questions: (1) perceived benefits (simplified self-care tasks, improved adherence to medications, enhanced communication and connection with healthcare providers, facilitated HF symptoms monitoring, improved HF knowledge, decreased hospitalization, and provided assurance of safety); (2) barriers (challenges of abandoning previous self-care strategies); (3) facilitators (perceived ease of use, availability of technical support); (4) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features).

Conclusion

Patients were satisfied with using mHealth apps for self-care. They perceived apps as a valuable tool for improving self-care ability and decreasing hospitalization rates. Personalization of app features and integration of mHealth apps with electronic health records are essential to sustain high-quality patient experiences related to app use for self-care.
Validation of the virtual measurement of the Essential Frailty Toolset
Authors: Sahota P , Yu M , Polderman J , Achtem L , Stephenson A , Morgan K , Lauck S
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The Essential Frailty Toolset (EFT) is a valid measurement of frailty in people with heart valve disease. COVID-19 has prompted the transition to virtual health consultations and necessitates the validation of the virtual assessment of frailty.

Methods

We conducted a prospective observational cohort study to compare the measurement of EFT in person and virtual format within a maximum 2-week window of repeated measurement. The weighted Kappa tests was used to measure the agreement of EFT scores between assessments; we explored the effect of the sequence of measurement using the Cochran-Mantel-Haenszel statistic to test the general association between the timing of measurement and differences of EFT score.

Results

We recruited a sample of 49 patients, with a mean age of 81 ± 7 years, including 29 men (59.2%); the primary valvular heart diseases were aortic stenosis (n=40, 81.6%), mitral regurgitation (n=2, 4.1%) and tricuspid regurgitation (n=7, 14.3%). The virtual measurement of frailty was conducted using a standardised protocol. The platform for virtual connection selected by patients was FaceTime (n=20, 40.8%) and Zoom (n=29, 59.2%); the median (IQR) number of days between the in-person and the virtual assessment was 5 (3,10). The weighted Kappa estimate was 0.69 (95% CI 0.55, 0.82), illustrating a strong agreement between the separate scores obtained. The test for the general association was non-significant (p=0.82), indicating a lack of evidence for detecting an association between EFT scores and chronological order of assessment.

Conclusion

The EFT can be reliably measured virtual in older patients with valvular heart disease to inform clinical care.
Perceptions of an eHealth family-based cardiovascular disease risk reduction intervention: a mixed methods study
Authors: Kemp B J , Thompson D R , Mcguigan K , Watson C J , Ski C F
Published: July 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland

Introduction

Controllable cardiovascular disease (CVD) risk factors are often initiated in the family home, yet risk reduction is seldom targeted toward families. Participatory design of eHealth interventions with end-users has potential to increase acceptability and adherence of such interventions. Despite their shared risk of developing CVD, few eHealth interventions target both parents and children at CVD risk. Therein lies an evidence gap; the need for coproduction of a family-based eHealth intervention aimed at early CVD prevention.

Purpose

The aim of this study was to identify the perceptions of families towards the design, functionality and acceptability of an eHealth, family-based, CVD prevention intervention.

Methods

Thee online focus groups comprising six families were conducted between April and May 2021. Families consisted of at least one parent who met CVD risk factor criteria, and at least one child aged five to 17 years. Content analysis and narrative synthesis were used to identify categories and subcategories regarding development of and engagement with the proposed intervention. Additionally, quantitative, and demographic measures were used to determine psychosocial and health profiles.

Results

Three categories were identified from the focus groups:

1) previous experiences of using health-related apps or devices

2) expectations of a newly developed eHealth family-based CVD prevention intervention

3) motivators for engagement with the intervention

Goal setting, rewards, accountability, adaptability, recording achievements and competition were considered crucial motivators for engagement for both parents and children. Participants welcomed the intervention, and advised they would prefer a free, personalised, easy-to-use, non-time-consuming intervention, with multiple content formats, and additional information available should they seek to access it. Parents conveyed satisfactory general self-efficacy and quality of life, low anxiety and depression and high perceived social support.

Conclusions

Overall, families were constructive and forthcoming towards the idea of an eHealth, family-based CVD prevention intervention. These findings informed a prototype of a family-based eHealth intervention aimed at early CVD prevention. The prototype is currently being developed with plans for piloting via a randomised controlled trial in the home environment, by families as an early intervention for the prevention of CVD.
Psychometric evaluation of the danish version of the electronic health literacy scale (eHEALS) in patients treated with percutaneous coronary intervention (PCI): A cross-sectional validation study
Authors: Palm P , Brors G , Borregaard B , Rasmussen T B , Helmark C , Norekval T
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

As many use the internet as a major source of health information, eHealth literacy has emerged as a potential concept for digital health care consumption. Therefore, healthcare professionals need to consider the eHealth literacy of patients when delivering health information to cardiac patients.

Purpose

The aim of this study was to translate and evaluate the psychometric properties of the Danish version of the Electronic Health Literacy Scale (eHEALS) in a population of Danish PCI treated patients.

Methods

The eHEALS was translated into Danish from the original English version, including forward translation, synthesis, backward translation and expert group consensus. The questionnaire was applied to a group of Danish PCI treated patients to be answered during hospital stay. Psychometric properties were assessed including internal consistency by Cronbach α, and confirmatory factor analysis (CFA) with a priori specified 1-, 2- and 3-factor models were performed to explore construct validity. Socio-demographic and patient-reported outcomes including health literacy, health-related internet use, and health status were collected to examine correlations with eHEALS scores.

Results

A total of 1473 PCI treated patients were included in the analysis. The mean age was 66 years (SD 10.70) and more patients were males (n=1130, 78%). The mean value for the eHEALS score was 28.87 (SD 6.34), and the Cronbach α 0.94. The CFA indicated a good fit for three out of four of the goodness-of -fit indices. A mean difference on the eHEALS score between patients with the highest and lowest educational level was found to be 4.64 (95%CI, 2.43-6.85), p<0.0001.

Strong correlations were observed between eHEALS scores and "ability to find good information"(r=0.636), "Understanding health information well enough to know what to do" (r=0.505), ‘patients’ perceived usefulness’ (r= 0.650) and ‘importance of using the internet’ (r=0.621). Moderate correlations were observed to ‘having used the internet to find information about health’ (r=0.464), and "Appraisal of health information" (r=0.462), and weak correlations to self-rated physical health (r=0.119), self-rated mental health (r=0.110), and social support (r=0.207).

Conclusion

The psychometric evaluation indicates that the Danish version of the eHEALS questionnaire is a valid instrument to measure eHealth literacy in patients treated with PCI, suggesting a multidimensional construct.
The experience of internet-delivered cognitive behavioural therapy among patients with non-cardiac chest pain
Authors: Eriksson-Liebon M , Lundgren J , Rytterstrom P , Johansson P , Mourad G
Published: July 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Kamprad Family Foundation

Region Östergötland

Background

Non-cardiac chest pain (NCCP) is a common health problem at emergency departments. Many patients are discharged with no further explanation regarding the cause of their chest pain. Recurring chest pain, functional limitations and cardiac anxiety affect lives of patients with NCCP and lead to increased healthcare use. Hence, we developed and tested a five-week, nurse-led iCBT program adapted to patients with NCCP in order to improve psychological distress and other patient-reported outcomes. This study was aimed to explore the experiences of patients with NCCP and cardiac anxiety regarding their participation in the iCBT program.

Methods

A qualitative interview study using content analysis to explore the experiences of patients participating in the iCBT program. The data was collected by individual face-to-face interviews with 16 patients after their participation in the iCBT using a semi-structured interview guide.

Results

The study resulted in three categories and eight subcategories, presented in Table 1. "Driving factors for participation in the iCBT program" was the first category and described the impact of pain on patients´ lives and their struggle before participating in the program. The second, "The program facilitates change", described how the program helped them make changes regarding pain, fear and anxiety. The last category, "Learning to live with chest pain", described the program as a tool for gaining the strength and skills to live a normal life despite chest pain.

Conclusions

The life impacted by recurrent chest pain, anxiety and feeling of being disregarded by healthcare was commonly experienced by participants. The invitation to the program was perceived as an opportunity to return to a normal life, without fear or chest pain. By being trustworthy, supportive and encouraging, the program helped participants to challenge their fear, and gain the strength and new insights they needed to live a normal life.
Quality of life and frailty: an important issue for elderly patients with an implanted pacemaker.
Authors: Bujak-Rogala E , Lisiak M H , Uchmanowicz I
Published: July 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Quality of life (QoL) and Frailty Syndrome (FS) are increasingly considered in the clinical evaluation after invasive cardiac procedures, such as pacemaker implantation in the elderly.

Purpose

The aim of the study was to report on the baseline to follow-up changes in QoL and FS in patients following pacemaker implantation.

Methods

The population of the study comprised 101 elderly patients (≥65 y/o) who were qualified for pacemaker implantation. The medical record analysis and self-administered questionnaire were used twice: before the implantation (Cardiology Department) and after 6 months (outpatient clinic). The following instruments were used: sociodemographic and clinical data, WHO Quality of Life and the Tilburg Frailty Indicator (TFI).

Results

The mean age of the participants (54 men) was 76.44 ± 6,92. The 6-month analysis showed that QoL scores in all domains were significantly higher than before implantation, respectively (p<0.001): physical domain (SD = 15.72 vs. SD = 21.17; T = 4810.50, z = - 8.154) psychological domain (SD = 27.55 vs. SD = 23.14; T = 4553.50, z = - 8.135), social domain (SD = 12.10 vs. SD = 17.36; T = 2396.50, z = - 6.776), and environmental domain (SD = 13.00 vs. SD = 16.80; T = 4414.00, z = - 7.932). The analysis of the FS showed that all FS components decreased compared to the subjects' score at baseline measurement (p<0.001), respectively: physical component level: SD = 1.42 vs. SD = 1.53; T = 3916, z = -9.381), psychological components (SD = 0.67 vs. SD = 0.94; T = 990, z = - 6.633), social components (SD = 0.83 vs. SD = 0.89; T = 300, z = - 4.899). The additional analysis revealed that age (in all domains) and FS (only in the physical domain) were predictors of better QoL. The results indicate that as age increases by one year, post-implantation QoL decreases by 0.4 points, B = -0.40; β = -0.18 (physical domain), by 0.89 points, B = -0.89; β = -0.22 (psychological domain), by 0.55 points, B = -0.55; β = -0.32 (social domain), and by 0.44 points, B = -0.44; β = -0.25 (environmental domain). In contrast, greater severity of FS symptoms before implantation is a significant predictor of lower QoL after implantation, B = -0.99; β = -0.40.

Conclusion(s)

The assessment of QoL and FS, in addition to the clinical assessment, should be performed in elderly patients qualified for pacemaker implantation. The results indicate that pacemaker implantation is an important factor in improving the QoL and reducing the severity of physical component of FS. Appropriate assessment may be helpful in optimizing the therapeutic management in terms of prognostic assessment and the risk of hospitalization.
Cardiovascular outcomes in transgender individuals in Sweden after initiation of gender-affirming hormone therapy
Authors: Karalexi Maria A , Frisell Thomas , Cnattingius Sven , Holmberg Dag , Holmberg Mats , Kollia Natasa , Skalkidou Alkistis , Papadopoulos Fotios C
Published: July 2022

Aims

We compared the incidence of cardiovascular disease (CVD) in transgender participants with a diagnosis of gender dysphoria (GD) with and without gender-affirming hormone therapy (GAHT) to the incidence observed in the general population.

Methods and results

The population-based cohort included all individuals >10 years in Sweden linked to Swedish nationwide healthcare Registers (2006–16). Two comparator groups without GD/GAHT were matched (1:10) on age, county of residence, and on male and female birth-assigned sex, respectively. Cox proportional models provided hazard ratios (HRs) and 95% confidence intervals (CI) for CVD outcomes. Among 1779 transgender individuals [48% birth-assigned males (AMAB), 52% birth-assigned females (AFAB)], 18 developed CVD, most of which were conduction disorders. The incidence of CVD for AFAB individuals with GD was 3.7 per 1000 person-years (95% CI: 1.4–10.0). Assigned male at birth individuals with GD had an incidence of CVD event of 7.1 per 1000 person-years (95% CI: 4.2–12.0). The risk of CVD event was 2.4 times higher in AMAB individuals (HR: 2.4, 95% CI: 1.3–4.2) compared with cisgender women, and 1.7 higher compared with cisgender men (HR: 1.7, 95% CI: 1.0–2.9). Analysis limited to transgender individuals without GAHT yielded similar results to those with GAHT treatment.

Conclusion

The incidence of CVD among GD/GAHT individuals was low, although increased compared with matched individuals without GD and similar to the incidence among GD/no GAHT individuals, thus not lending support for a causal relationship between treatment and CVD outcomes. Larger studies with longer follow-up are needed to verify these findings, as well as possible effect modification by comorbidity.
TARGET-HF: developing a model for detecting incident heart failure among symptomatic patients in general practice using routine health care data
Authors: De Clercq Lukas , Schut Martijn C , Bossuyt Patrick M M , van Weert Henk C P M , Handoko M Louis , Harskamp Ralf E
Published: July 2022

Background

Timely diagnosis of heart failure (HF) is essential to optimize treatment opportunities that improve symptoms, quality of life, and survival. While most patients consult their general practitioner (GP) prior to HF, the early stages of HF may be difficult to identify. An integrated clinical support tool may aid in identifying patients at high risk of HF. We therefore constructed a prediction model using routine health care data.

Methods

Our study involved a dynamic cohort of patients (≥35 years) who consulted their GP with either dyspnoea and/or peripheral oedema within the Amsterdam metropolitan area from 2011 to 2020. The outcome of interest was incident HF, verified by an expert panel. We developed a regularized, cause-specific multivariable proportional hazards model (TARGET-HF). The model was evaluated with bootstrapping on an isolated validation set and compared to an existing model developed with hospital insurance data as well as patient age as a sole predictor.

Results

Data from 31,905 patients were included (40% male, median age 60 years) of whom 1,301 (4.1%) were diagnosed with HF over 124,676 person-years of follow-up. Data were allocated to a development (n = 25,524) and validation (n = 6,381) set. TARGET-HF attained a C-statistic of 0.853 (95% CI, 0.834 to 0.872) on the validation set, which proved to provide a better discrimination than C = 0.822 for age alone (95% CI, 0.801 to 0.842, P < 0.001) and C = 0.824 for the hospital-based model (95% CI, 0.802 to 0.843, P < 0.001).

Conclusion

The TARGET-HF model illustrates that routine consultation codes can be used to build a performant model to identify patients at risk for HF at the time of GP consultation.
Unintended Consequences of Pandemic Management Strategies on Residents and Family in One Long-term Care Home in British Columbia: A Patient-Supported Qualitative Study
Authors: Staempfli Sabina , Havaei Farinaz , Phinney Alison , MacPhee Maura
Published: July 2022

Background and Objectives

In March 2020, pandemic management strategies were mandated across long-term care homes in British Columbia, Canada, to control the effects of COVID-19. This study describes and contextualizes the impact of visitation, infection prevention and control, and staffing strategies on the perceived health and well-being of residents and families.

Research Design and Methods

This interpretive description study was part of a larger mixed-methods study at a publicly funded not-for-profit long-term care home in British Columbia, Canada. Eleven family members and 10 residents were interviewed between October and December 2020, and resident and family partners participated in a steering committee throughout all stages of the research.

Findings

Early pandemic management strategies had an adverse impact on the perceived health and well-being of families and residents. Visitation restrictions eliminated care routinely provided by families and prevented in-person communication between residents, families, and care providers. Other infection prevention and control strategies isolated residents; group enrichment programs were stopped, and lockdowns created a perception of incarceration. Donning and doffing personal protective equipment took time away from staff–resident interactions and the single-site order reduced staff numbers, placing additional time restraints on residents’ care.

Discussion and Implications

Unintended adverse consequences of pandemic management strategies demonstrate the risks of creating policies based on a medicalized definition of health. Clear lines of communication are vital to increase a sense of control for families and residents. Elimination of care provided by families and paid companions exposed a gap in Canada’s public long-term care system. This care gap raises concerns about equitable care access for residents without families or financial means to pay for additional care.
Primary Care Professionals’ Attitudes Towards Vaccination Recommendation for Patients With Inflammatory Bowel Disease
Authors: Xu Fang , deJong Neal , Kappelman Michael D , Greenlund Kurt J , Carlson Susan A
Published: July 2022

Background

Immunization among patients with inflammatory bowel disease (IBD) is suboptimal. We sought to characterize attitudes of US primary care professionals (PCPs) towards immunization practices for patients with IBD.

Methods

Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2021, cross-sectional study), we assessed likelihood of PCPs’ recommending influenza, pneumococcal disease, herpes zoster, and human papilloma virus vaccinations for IBD patients by PCP characteristics and availability of clinical tools. Reasons for unlikelihood of recommending vaccines and approaches to improve vaccine recommendation were examined.

Results

Among 1503 PCPs, 64% recommended all vaccines. Herpes zoster vaccine was most likely to be recommended (89.8%) and pneumococcal vaccine was least likely (74.0%). Clinical tools including decision support based on electronic health records (EHRs; 48.9%) and staff tracking of patients’ vaccine needs (36.3%) were significantly associated with likelihood of recommending vaccines (P < .001). A greater likelihood of vaccine recommendation was observed for pediatricians vs other medical specialties, group outpatient clinic vs other worksites, and seeing >50 patients/week (P < .05). One-third of PCPs were unlikely to recommend ≥1 vaccine, and the top reason reported was unfamiliarity with vaccine guidelines for patients with IBD (48.0%). A review of guidelines or continued medical education (63.0%) and decision support from EHRs (51.2%) were the most frequently selected approaches identified to improve certainty of vaccine recommendation.

Conclusions

There is room for improvement of vaccination recommendations by PCPs. Promoting continuing education and use of clinical tools may help support PCP immunization practices for patients with IBD.
Migrant Workers and Wage Theft: Is Legal Action an Effective Form of Collective Action?
Authors: O’Sullivan Michelle , MacMahon Juliet
Published: July 2022

Vulnerable migrant workers are generally very reluctant to take legal action to challenge exploitation given the many obstacles they face, and instances of such action are important to examine for their exceptionality. This article presents a case study of non-unionised Portuguese construction workers who engaged in a lengthy legal battle against their Portuguese employers for various forms of wage theft while they worked in Ireland. The aim of the article is to assess the extent to which their legal action was an effective form of collective action. To do so, we draw on industrial relations and law literature to explore the purposes of collective action and litigation and apply this understanding to assess the outcomes of the migrant workers’ legal cases. We find that the workers’ legal action was a partially effective form of collective action that sought to address the source of their discontent. The case study highlights the regulatory dilemmas that arise in an institutional environment where workers ability to engage in voluntarist forms of collective action is constrained and they seek to use the legal system as collective subjects.
Immunogenicity, efficacy and safety of COVID-19 vaccines: an update of data published by 31 December 2021
Authors: Xu Kun , Fan Chunxiang , Han Yuxuan , Dai Lianpan , Gao George F
Published: July 2022

The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused a disaster for public health in the last 2 years, without any sign of an ending. Various vaccines were developed rapidly as soon as the outbreak occurred. Clinical trials demonstrated the reactogenicity, immunogenicity and protection efficacy in humans, and some of the vaccines have been approved for clinical use. However, waves of infections such as the recently circulating Omicron variant still occur. Newly emerging variants, especially the variants of concern, and waning humoral responses pose serious challenges to the control of the COVID-19 pandemic. Previously, we summarized the humoral and cellular immunity, safety profiles and protection efficacy of COVID-19 vaccines with clinical data published by 21 May 2021. In this review, we summarize and update the published clinical data of COVID-19 vaccines and candidates up to 31 December 2021.