A systematic review of telemonitoring for the management of heart failure

BACKGROUND: Telemonitoring allows a clinician to monitor, on a daily basis, physiological variables measured by patients at home. This provides a means to keep patients with heart failure under close supervision, which could reduce the rate of admission to hospital and accelerate discharge. OBJECTIVE: To review the literature on the application of telemedicine in the management of heart failure. METHODS: A literature search was conducted on studies involving telemonitoring and heart failure between 1966 and 2002 using Medline, Embase, Cochrane Library and Journal of Telemedicine and Telecare. RESULTS: Eighteen observational studies and six randomised controlled trials involving telemonitoring and heart failure were identified. Observational studies suggest that telemonitoring; used either alone or as part of a multidisciplinary care program, reduce hospital bed-days occupancy. Patient acceptance of and compliance with telemonitoring was high. Two randomised controlled trials suggest that telemonitoring of vital signs and symptoms facilitate early detection of deterioration and reduce readmission rates and length of hospital stay in patients with heart failure. One study also showed a reduction in readmission charges. One substantial randomised controlled study showed a significant reduction in mortality at 6 months by monitoring weight and symptoms in patients with heart failure; however, no difference was observed in readmission rates. Another randomised study comparing video-consultation performed as part of a home health care programme for patients with a variety of diagnoses, suggested a reduction in the costs of hospital care, which offset the cost of video-consultation. Patients with heart failure were not reported separately. One randomised study showed no difference in outcomes between the telemonitoring group and the standard care group. CONCLUSION: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention.     

Shared decision making with frail older patients: Proposed teaching framework and practice recommendations

ABSTRACT

This study has two aims: The first aim is to identify core competencies for shared decision making (SDM) with frail older persons, and the second is to determine key elements of a teaching framework, based on the authors’ recently developed model for SDM with older patients who are frail. To this end the authors conducted a qualitative inquiry among health professionals (n = 53) and older patients who are frail (n = 16). Participants formulated core competencies and educational needs for SDM with older patients who are frail, which were further explored in the literature. This resulted in practice recommendations and a teaching framework with the following key elements: create a knowledge base for all health professionals, offer practical training, facilitate communication, identify discussion partners, engage patients, and collaborate. The authors’ teaching framework for SDM with older patients who are frail may be useful for clinicians, educators, and researchers who aim to promote SDM with older patients who are frail.     

Disability and need for rehabilitation among patients with inflammatory bowel disease.

Physicians who manage patients with inflammatory bowel disease (IBD) as well as the patients themselves need to know about the prospects of disability and the demand for rehabilitation associated with this chronic disease. The present study uses German social security statistics to characterize IBD patients undergoing a rehabilitation or having a disability and their employment status before and after rehabilitation. Each year, about 9 and 3% of all German employees with IBD underwent a rehabilitation or were granted a disability pension, respectively. In comparison with other diseases, IBD patients tended to be young, female and employed in white-collar occupations. Although they had significantly longer sick leaves, 87% were still employed before entering rehabilitation. The majority, i.e. 72%, improved under rehabilitation. Compared with other diseases, however, rehabilitation of patients with IBD was less successful, i.e. less patients improved, and more patients remained unchanged or even worsened during rehabilitation. After rehabilitation, continuation of the last employment was recommended in 82% of the cases, in 94% after additional medical or vocational measures. Overall, failed rehabilitation led to a similar rate of disability in IBD as in other diseases. Within the IBD population, however, female sex and white-collar occupations were associated with an increased risk, while male sex and blue-collar occupations were associated with a reduced risk for disability. These data reflect the underlying epidemiology of IBD as well as its natural history. Despite its severity and chronicity, the overwhelming majority of patients with IBD manage to stay in the work force and succeed in overcoming the obstacles posed by their disease.     

Pulmonary rehabilitation: an integral part of the long-term management of COPD

Pulmonary rehabilitation comprises a variety of interventions grouped into three main categories: exercise training, education, and psychological support. Typically, patients participate in a programme of exercise rehabilitation 2-3 times a week for 6-12 weeks, at the same time being encouraged to incorporate breathing and stretching exercises as part of their daily routine. The physiological rationale for pulmonary rehabilitation in COPD is primarily based on its effect on peripheral muscle dysfunction. A recent meta-analysis demonstrated that pulmonary rehabilitation is effective in reducing dyspnoea and fatigue as well as improving patients' sense of control (mastery) over their condition. Without compliance with a maintenance programme these improvements will diminish with time. The value of various components of rehabilitation, programme length, the required degree of supervision, the intensity of training and the best approach to maintaining programme adherence represent issues that remain to be explored.     

The need for speed in the management of haemophilia patients with inhibitors

Summary. Rapid control of bleeding is the key to reducing bleeding complications and thereby preserving joint and musculoskeletal function in haemophilia patients with inhibitors. However, this requires early diagnosis following the onset of bleeding and strategies for rapid treatment in an outpatient setting. Overarching themes on the need for speed in managing bleeds in haemophilia patients were examined by a panel of clinicians experienced in managing inhibitor patients and joint disease during the Third Zürich Haemophilia Forum on 8 May 2009. This report summarizes the opinions of the panel on how to achieve rapid bleeding control in inhibitor patients and areas that were identified by the panel for future research or as needing new consensus guidelines. The consensus was that home treatment should be established for haemophilia patients with inhibitors, as it is associated with a faster time to treatment, as well as improvements in the quality of life of patients and their carers. In addition, as improved haemostatic control now allows inhibitor patients to participate in a wider range of physical activities, specific guidelines are required on which types of sport and work are appropriate. It was agreed that clear, systematic approaches are needed for early diagnosis of joint and muscle bleeds in inhibitor patients, which could facilitate rapid treatment. There may be opportunities for exploiting new diagnostic techniques from osteoarthritis to enable earlier diagnosis of haemophilic arthropathy. Overall, it was concluded that greater emphasis should be placed on education and patients’ psychological needs, to enable inhibitor patients to cope up more effectively with their disease.     

A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients

BACKGROUND: the usefulness of geriatric evaluation and management (GEM) approaches in the care of frail elderly patients remains uncertain. We examined whether an inpatient geriatric consultation service might be beneficial in a country with a social welfare system. METHODS: we conducted a randomised trial with 345 patients from five centres. Ninety additional patients from four separate centres without GEM teams served as an external comparison. All patients were hospitalised, at least 65 years and frail. Patients were randomly assigned to either comprehensive geriatric assessment and management in the form of consultations and follow-up or usual care. Primary outcomes were rehospitalisation and nursing home placement 1 year after randomisation. Secondary outcomes were survival, functional, emotional and cognitive status, social situation and quality of life. FINDINGS: at 12 months, the groups did not differ in the rate of rehospitalisation (intervention 67%, control 60%, P=0.30), nursing home placement (intervention 19%, control 14%, P=0.27), survival (intervention 81%, control 85%, P=0.56) or any of the other secondary measures. The external comparison groups were also similar in nursing home placement (16%, P=0.40), survival (80%, P=0.88) and all the secondary variables, but rehospitalisation was less (48%, P=0.04). No subgroup benefited from the intervention. INTERPRETATION: care provided by consultation teams did not improve the rates of rehospitalisation or nursing home placement. This is not due to carry-over effects of geriatric knowledge into the control group.     

衰弱老年人的功能康复研究进展及对康复护理实践的启示

衰弱严重影响老年人健康状况和生活质量,要重视对衰弱前期的早识别、早预防,避免衰弱进展及失能。功能康复对于预防和逆转衰弱至关重要,主要方法包括运动康复、心脏康复,并逐渐扩展到肺康复和吞咽康复等方面。护理人员应当在老年人衰弱康复中发挥积极作用,建立以护理人员为主导的衰弱康复体系;立足主动健康,将康复干预关口前移,同时重点关注中重度衰弱的高龄老年人;采用综合康复护理策略,可通过互联网+照护者陪伴运动的方式提高高龄老人康复锻炼依从性和安全性。     

改善支气管哮喘控制现状，需要重视患者的长期管理

支气管哮喘（bronchialasthma,简称哮喘）是全球范围内最常见的慢性疾病之一。全世界的哮喘患病率差别很大。加拿大的资料显示,在加拿大哮喘是女性终身累计患病率占第一位的疾病,也是男性占第二位的疾病。一般来说,欧美发达国家的发病率明显高于我国。我国的哮喘发病率约为1％一4％,儿童显著高于成人。全球哮喘患者约为3亿左右,在中国估计有哮喘患者3000万左右。而且,近年来我国哮喘的发病率仍在呈缓慢升高的趋势。这与欧美过去的情况是相似的,随着经济的发展,生活水平的提高,     

Fragility fractures in HIV-infected patients: need for better understanding of diagnosis and management

HIV infection, AIDS, and antiretroviral therapy (ART) have been associated with bone fragility fractures, although the prevalence and incidence are not well studied by researchers. In HIV and ART, osteopenia and osteoporosis are multifactorial, and health promotion or medical health maintenance should anticipate and prevent morbidity of bone fragility fractures.     

Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring

The prevalence of hypertension is high and still increasing in almost all communities regardless of high, middle, or low income. The control rate remains low in most countries. Telemedicine offers possibilities to improve blood pressure control. The past two decades witnessed the fast evolving telecommunication from telephone transmission to smart mobile phone technology for telemedicine. There is some evidence from randomized controlled trials that telemonitoring improves blood pressure control. However, it requires co‐interventions. The emerging new technology may offer even more possibilities in telemonitoring and co‐interventions, for instance, an interactive platform between patients and health professionals for the management of hypertension. Telemedicine might ultimately change the situation of the unsatisfactory management of hypertension in many communities. It helps fully utilize antihypertensive treatment, the most effective cardiovascular prevention, to achieve the goal of ending atherosclerosis and arteriosclerosis in humans.     

Evaluating the impact of personalized rehabilitation nursing intervention on postoperative recovery of respiratory function among thoracic surgery patients: A protocol for systematic review and meta-analysis

Background:Owing to clinical developments and economic strain, perioperative care has undergone considerable changes. Therefore, it is important to review and critique the efficacy of existing practices in a context that is placing increasing emphasis on better efficacy and cost-containment. Considering that the objective involves devising approaches to minimize postoperative complications and reduce medical care, efforts should concentrate on postsurgical pulmonary complications that are common. The present analysis aims to examine how customized rehabilitation nursing intercession impacts the postsurgical restoration of respiratory functions in thoracic surgery patients.Methods:Prespecified search strategies will be employed to perform a methodological search of 6 databases namely EMBASE, Cochrane Library, PubMed, Web of Science, WanFang Database, and China National Knowledge Infrastructure. The analysis will comprise original publications that evaluated how personalized rehabilitation nursing intervention impacts postsurgical restoration of respiratory function in those who have undergone thoracic surgery. All considered publications are before December 25, 2021. Different authors will conduct an independent study selection process to evaluate the quality of the publications and extract required data. Based on the standardized mean difference and its 95% confidence interval, we estimate the summary effects for each meta-analyses. Based on heterogeneity in considered articles, the related data will be pooled through either a random- or fixed-effect meta-analysis. Lastly, the overall quality of evidence using appropriate methods will be performed.Results:The results of this analysis will systematically evaluate how customized rehabilitation nursing interference impact postsurgical healing of respiratory functions in patients who have undergone thoracic surgery by collecting the existing evidence.Ethics and dissemination:Not required.Open Science Framework registration number:10.17605/OSF.IO/NBVYW.     

The long-term effects of individual cardiac rehabilitation in patients with coronary artery disease

BackgroundThe positive effects of cardiac rehabilitation have been repeatedly described and are well-known over the short- and middle-term periods. However there is less knowledge about long-term outcomes in patients with chronic stable coronary artery disease.AimThe aim of this study was to evaluate the long-term outcome of individual cardiac rehabilitation in patients with coronary artery disease.MethodsOne hundred fifty-two patients with stable coronary artery disease were retrospectively divided into two groups according to their adherence to individual physical activity recommendations, regardless of their participation in guided cardiac rehabilitation training. The IT+ group which participated in individual exercise programmes according to recommendations was compared with patients who declined these activities (the IT− group). The median follow-up period was 12.7 years.ResultsThe individual training had no long-term effect on survival after being checked for other possible contributing factors, but the multivariate analysis showed a significant association with the occurrence of cardiac events like myocardial infarction, unstable angina, coronary revascularization and hospitalization for heart failure: HR (95% CI) 0.51 (0.30–0.89); p = 0.017.ConclusionHome based cardiac rehabilitation and regular physical activity significantly improve long-term cardiac morbidity in patients with coronary artery disease.     

Physician management preferences for cardiac patients: factors affecting referral to cardiac rehabilitation

BACKGROUND: Cardiac rehabilitation (CR) is an evidence-based intervention that has been shown to reduce both morbidity and mortality. However, CR is widely underused due to multiple factors, including physician referral practices. OBJECTIVES: To describe physicians' preferences in managing cardiac patients and the barriers they face in referring patients to CR. METHODS: A cross-sectional survey of a stratified random sample of 510 primary care physicians, cardiologists and cardiovascular surgeons in Ontario was conducted. One hundred seventy-nine physicians responded (40% response rate through repeat mailings) to the survey that investigated medical, demographic and attitudinal factors affecting referral. A hypothetical case scenario that elicited open-ended factors affecting physician management preferences was incorporated. RESULTS: Physicians identified geographic access, uncertainty regarding which provider was responsible for referral and perceptions of patient motivation as important factors affecting referral to CR. Through principal components analysis, several attitudes affecting referral emerged, including beliefs about the efficacy of CR, referral norms, ease of the referral process and desire to manage the patient independently. A hierarchical logistic regression analysis showed that 75% of the variance in referral was attributable to medical specialty, availability of CR and practice norms. CONCLUSIONS: Increased communication among health care providers is needed to ensure CR referral. Due to geographic dispersion, alternatives to site-based CR are necessary to meet the needs of cardiac patients.