Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of “Choosing Wisely” recommendations in degenerative knee disease

Abstract Purpose The purpose of this study was to assess which factors were associated with the implementation of “Choosing Wisely” recommendations to refrain from routine MRI and arthroscopy use in degenerative knee disease. Methods Cross-sectional surveys were sent to 123 patients (response rate 95%) and 413 orthopaedic surgeons (response rate 62%) fulfilling the inclusion criteria. Univariate and multivariate logistic regression analyses were used to identify factors associated with implementation of “Choosing Wisely” recommendations. Results Factors reducing implementation of the MRI recommendation among patients included explanation of added value by an orthopaedic surgeon [OR 0.18 (95% CI 0.07–0.47)] and patient preference for MRI [OR 0.27 (95% CI 0.08–0.92)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own MRI experience than existing evidence [OR 0.41 (95% CI 0.19–0.88)] and higher estimated patients’ knowledge to participate in shared decision-making [OR 0.38 (95% CI 0.17–0.88)]. Factors reducing implementation of the arthroscopy recommendation among patients were orthopaedic surgeons’ preferences for an arthroscopy [OR 0.03 (95% CI 0.00–0.22)] and positive experiences with arthroscopy of friends/family [OR 0.03 (95% CI 0.00–0.39)]. Factors reducing implementation among orthopaedic surgeons were higher valuation of own arthroscopy experience than existing evidence [OR 0.17 (95% CI 0.07–0.46)] and belief in the added value [OR 0.28 (95% CI 0.10–0.81)]. Conclusions Implementation of “Choosing Wisely” recommendations in degenerative knee disease can be improved by strategies to change clinician beliefs about the added value of MRIs and arthroscopies, and by patient-directed strategies addressing patient preferences and underlying beliefs for added value of MRI and arthroscopies resulting from experiences of people in their environment. Level of evidence IV.

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Individual, family, and community factors related to loneliness in mothers raising children less than 3 years of age: a cross-sectional study

BMC Women s Health ◽

10.1186/s12905-021-01365-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Azusa Arimoto ◽

Etsuko Tadaka

Keyword(s):

Social Isolation ◽

Response Rate ◽

Child Outcomes ◽

Family Factors ◽

Cross Sectional ◽

Community Factors ◽

Raising Children ◽

Factors Associated ◽

Systems Model ◽

Individual Family

Abstract Background Loneliness in mothers raising children under 3 years of age is a major challenge. The purpose of this study was to identify the individual, family, and community factors associated with loneliness among mothers raising children under 3 years of age with social isolation as a mediator. Methods A cross-sectional survey was conducted using anonymous self-administered questionnaires. The target population was all 649 mothers of children under 3 years of age visiting a public health center in Yokohama City and eligible for child health examinations between November 2019 and February 2020. The study measures included loneliness (10-item version of the UCLA Loneliness Scale), social isolation (Lubben Social Network Scale [LSNS-6]), demographic data, individual factors, family factors, and community factors from an ecological systems model. Social isolation was classified based on the LSNS-6 cutoff points. Multiple regression analysis was conducted to examine the association between loneliness and individual, family, and community factors with social isolation as a mediator. Results A total of 531 participants (81.8% response rate) responded, and 492 (75.8% valid response rate) were included in the analysis. Loneliness was significantly higher in the isolated group (n = 171, 34.8%) than in the non-isolated group (n = 321, 65.2%) (mean = 22.3, SD = 5.6 and mean = 17.6, SD = 4.6, respectively). Factors associated with high loneliness included individual and family factors (a high number of parenting and life concerns [β = 0.211, p < 0.01], not eating breakfast every day [β = 0.087, p < 0.05], and fewer partners’ supportive behaviors for household duties and childcare [β = − 0.240, p < 0.001]) and community factors (fewer people to consult about parenting [β = − 0.104, p < 0.01] and low community commitment [β = − 0.122, p < 0.05]) with social isolation as a mediator. Conclusion Referral to a counseling organization to alleviate worries about parenting and the creation of a child-rearing environment to enhance the recognition of the community may be considered. These findings could help develop intervention programs for the prevention or alleviation of loneliness experienced by mothers and prevent the associated health risks among mothers and child outcomes.

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Overnight call is associated with poor resting heart rate and heart rate variability in orthopaedic surgeons

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000273 ◽

2019 ◽

Vol 4 (3) ◽

pp. 123-126

Author(s):

Kyle R Sochacki ◽

David Dong ◽

Leif Peterson ◽

Patrick C McCulloch ◽

Kevin Lisman ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Orthopaedic Surgery ◽

Resting Heart Rate ◽

Linear Regression Models ◽

Level Of Evidence ◽

Cross Sectional ◽

Hours Worked ◽

Significance Level ◽

Orthopaedic Surgeons

ObjectivesThe purpose of this study was to determine orthopaedic surgery residents’ and attending surgeons’ resting heart rate (RHR) and heart rate variability (HRV) and if there is a correlation between subject-specific variables (age, attending surgeon, resident, postgraduate year (PGY) level, gender, number of calls, total hours worked, and total hours of sleep) and surgeon RHR and HRV.MethodsOrthopaedic surgery residents and attending surgeons at a single institution were prospectively enrolled and provided a validated wearable device to determine hours of sleep, RHR and HRV. Demographic information, hours worked and overnight calls were recorded. Bivariate correlations were determined using the Spearman rank correlation. Multiple linear regression models were constructed to determine the effect of relevant variables. All p values were reported, and a significance level of α=0.05 was used (p<0.05).ResultsTwenty-one of 26 enrolled subjects completed the 4-week study. The average RHR and HRV for orthopaedic surgeons was 61.8+10.0 bpm and 42.96+21.2ms, respectively. Residents had a significantly higher RHR (66.4+8.4 vs 55.6+8.9, p=0.011) compared with attending surgeons. Overnight calls had the strongest association with decreased HRV (r=−0.447; p=0.038), moderate positive correlation with RHR (r=0.593; p=0.005) and weak negative correlation with HRV (r=−0.469; p=0.032). There was no significant correlation between PGY level, gender, total hours worked and total hours of sleep with RHR or HRV.ConclusionOrthopaedic surgeons have poor RHR and HRV. Additionally, the number of overnight calls had the strongest correlation with worse RHR and HRV.Level of evidenceLevel II; diagnostic, individual cross-sectional study with a consistently applied reference standard.

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Increased Incidence of Injury Among Runners With COVID-19

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211061144 ◽

2021 ◽

pp. 194173812110611

Author(s):

Brett G. Toresdahl ◽

James N. Robinson ◽

Stephanie A. Kliethermes ◽

Jordan D. Metzl ◽

Sameer Dixit ◽

...

Keyword(s):

New York ◽

Cross Sectional Study ◽

Multiple Organ ◽

Medical Professional ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Direct Role ◽

Cross Sectional ◽

Electronic Survey ◽

Organ Systems

Background: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. Hypothesis: Runners who report having COVID-19 also report a higher incidence of injury. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. Results: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 ( P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). Conclusion: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. Clinical Relevance: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.

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Perspectives in Treatments of End-Stage Ankle Arthritis Among Orthopaedic Surgeons

Foot & Ankle Orthopaedics ◽

10.1177/2473011418779976 ◽

2018 ◽

Vol 3 (3) ◽

pp. 247301141877997

Author(s):

Phinit Phisitkul ◽

Natalie Glass ◽

Patrick B. Ebeling ◽

Sandra E. Klein ◽

Jeffrey E. Johnson

Keyword(s):

United States ◽

The United States ◽

Total Ankle Replacement ◽

Ankle Arthritis ◽

Cross Sectional Survey ◽

Level Of Evidence ◽

Cross Sectional ◽

Orthopaedic Surgeons ◽

Ankle Replacement ◽

End Stage

Background: This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method: A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results: Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role ( P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon’s experience affected the consideration of these clinical factors as contraindications. Conclusions: Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence: Level III, therapeutic.

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Understanding of Prognosis Among Parents of Children With Cancer: Parental Optimism and the Parent-Physician Interaction

Journal of Clinical Oncology ◽

10.1200/jco.2006.08.3170 ◽

2007 ◽

Vol 25 (11) ◽

pp. 1357-1362 ◽

Cited By ~ 108

Author(s):

Jennifer W. Mack ◽

E. Francis Cook ◽

Joanne Wolfe ◽

Holcombe E. Grier ◽

Paul D. Cleary ◽

...

Keyword(s):

Decision Making ◽

Functional Outcome ◽

Response Rate ◽

Cross Sectional Survey ◽

Children With Cancer ◽

Cross Sectional ◽

Factors Associated ◽

Dana Farber Cancer Institute ◽

Unrealistic Expectations

Purpose Patients often overestimate their chances of surviving cancer. Factors that contribute to accurate understanding of prognosis are not known. We assessed understanding of likelihood of cure and functional outcome among parents of children with cancer and sought to identify factors that place parents at risk for overly optimistic beliefs about prognosis. Patients and Methods We conducted a cross-sectional survey of 194 parents of children with cancer (response rate, 70%) who were treated at the Dana-Farber Cancer Institute and Children's Hospital in Boston, MA, and the children's physicians. Parent and physician expectations for likelihood of cure and functional outcome were compared. In 152 accurate or optimistic parents, we determined factors associated with accurate understanding of likelihood of cure compared with optimism. Results The majority of parents (61%) were more optimistic than physicians about the likelihood of cure. Parents' beliefs about other outcomes of cancer treatment were similar (quality-of-life impairment, P = .70) or more pessimistic (physical impairment, P = .01; intellectual impairment, P = .01) than physicians' beliefs. Parents and physicians were more likely to agree about chances of cure when physicians had confidence in knowledge of prognosis (odds ratio [OR] = 2.55, P = .004) and allowed parents to take their preferred decision-making role (OR = 1.89, P = .019). Conclusion Parents of children with cancer are overly optimistic about chances of cure but not about other outcomes of cancer therapy. Parents tend to be overly optimistic about cure when physicians have little confidence and when the decision-making process does not meet parents' preferences. These findings suggest that physicians are partly responsible for parents' unrealistic expectations about cure.

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PREVALENCE AND FACTORS ASSOCIATED WITH INJURIES IN RECREATIONAL RUNNERS: A CROSS-SECTIONAL STUDY

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220202603190923 ◽

2020 ◽

Vol 26 (3) ◽

pp. 215-219 ◽

Cited By ~ 1

Author(s):

Maria Eduarda Ferreira Costa ◽

Jader Barbosa Fonseca ◽

Ana Izabela Sobral de Oliveira ◽

Kryslly Danielle de Amorim Cabral ◽

Maria das Graças Rodrigues de Araújo ◽

...

Keyword(s):

Cross Sectional Study ◽

Musculoskeletal Injuries ◽

Sectional Study ◽

Level Of Evidence ◽

Cross Sectional ◽

Factors Associated ◽

Demographic Questionnaire ◽

Chi Squared ◽

Running Injuries ◽

History Of

ABSTRACT Introduction The increased number of people who choose running as a form of exercise has been associated with a higher prevalence of musculoskeletal injuries. Objectives To determine the prevalence and the factors that could be correlated with injuries among amateur runners in Recife, in the State of Pernambuco (PE), Brazil. Methods An observational, cross-sectional study, in which 300 (three hundred) amateur runners answered a social demographic questionnaire, as well as questions about training characteristics, footstrike and landing pattern, and history of running injuries. The data were analyzed by descriptive statistics, the student-t test to compare means, and the Chi-squared to compare prevalences. Results The prevalence of injuries amongst runners in Recife-PE was 58.5% (n= 175), the knee being the most commonly injured site (37.3%). In both groups - runners with and without injuries – there was a higher number of male runners, with 72.4% and 72.6% respectively. There was no difference in relation to the weekly frequency of running between the groups (p<0.63). However, runners with a history of injuries ran around 7 kmh a week more than the runners without injuries (p<0.03). A neutral footstrike (F=0.87; p=0.99) and hindfoot landing (F=4.13; p=0.90) were the most reported running patterns in both groups. It was found that wear was the main criterion used for changing running shoes in both groups (F = 8.35, p = 0.4). Conclusion There was a high prevalence of musculoskeletal injuries among amateur runners in Recife-PE. Among the factors associated with the injuries, one variable was significant: a higher weekly volume of training. Level of evidence II; Study type: Cross-sectional study.

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Burnout Rates Amongst General Orthopaedic Surgeons and Subspecialists

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00066 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0006

Author(s):

Robert Nugent ◽

Tara E. Gaston ◽

Michael Markowitz ◽

Joseph N. Daniel ◽

Quincy Cheesman

Keyword(s):

Sports Medicine ◽

Demographic Data ◽

Maslach Burnout Inventory ◽

Well Being ◽

Older Age ◽

Personal Accomplishment ◽

Cross Sectional ◽

Orthopaedic Surgeons ◽

Factors Associated ◽

Increased Risk

Category: Other Introduction/Purpose: Burnout affects physicians in a multitude of ways, resulting in low levels of personal accomplishment (PA), depersonalization (DP), and high emotional exhaustion (EE). Overall, burnout has a direct impact on physician well-being and can negatively impact personal relationships, contribute to drug or alcohol use, and result in reduced outcomes in the work field. Although orthopaedic surgeon burnout rates of up to 50-60% have been reported, there have been no studies comparing burnout rates by orthopaedic subspecialty. The primary goal of this study is to examine the prevalence of burnout amongst orthopedic generalists and subspecialists. Given that a multitude of factors may contribute to burnout, a secondary goal is to identify trends in demographic data that may contribute to burnout. Methods: This was a multicenter, cross-sectional study conducted from March 2019 through December 2019 involving 149 orthopaedic surgeons with all orthopaedic subspecialties represented. The survey utilized an abbreviated 12-item Maslach Burnout Inventory - Human Services Survey (aMBI-HSS) to assess burnout. The aMBI-HSS consisted of three subcategories; PA, DP, and EE, each of which represented their own burnout score. Depression was also assessed in order to identify any correlation to increased burnout. Finally, independent factors, including demographics, personal characteristics, professional characteristics, and family life/spousal support were collected to assess how they contributed to burnout. Univariate and bivariate regression was performed to identify independent variables for multivariate regression analysis. Three separate generalized linear regressions were then performed to assess which independent factors led to an increase or decrease in the EE, DP, or PA burnout scores. Results: Mean burnout amongst all respondents was 62.29%, with 16.7% screening positive for depression. Oncology (100%), Sports Medicine (67.70%), and Trauma (62.50%) were the three specialties with highest burnout. In contrast, lowest burnout rates were seen in Shoulder and Elbow (50.0%), Pediatrics (51.6%), and Foot and Ankle (53.8%). Trauma (50.0%), Oncology (40.0%), and General (20.0%) had the highest rates of depression, while Shoulder and Elbow (0.00%), Spine (0.00%), and Sports Medicine (6.5%) had the lowest rates of depression. Independent factors associated with increased risk of burnout included Oncology subspecialty, older age, and increased debt. Contrarily, independent factors associated with decreased burnout were more years in practice, more hours worked per week, more time spent with family and close friends, work environment satisfaction, and home life satisfaction. Conclusion: Burnout is a growing problem amongst physicians. This study sought to determine which orthopaedic subspecialties had the highest rates of burnout and depression, while identifying any secondary contributing factors. Our study found that orthopaedic Trauma and Oncology had the highest rates of burnout and depression. Additionally, older age and higher debt load contributed to an increased rate of burnout and depression. As this is only a small representation of the orthopaedic surgical community, larger studies are necessary to help further understand burnout and elucidate effective treatment options for orthopaedic surgeons.

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Comparison of the factors associated with preference of life-sustaining treatment by caregivers’ and health facility tenants’ families: a cross-sectional study

10.21203/rs.3.rs-15510/v1 ◽

2020 ◽

Author(s):

Fumio Shaku ◽

Madoka Tsutsumi ◽

Asumi Nakamura ◽

Hiroshi Takagi ◽

Takahiro Otsuka ◽

...

Keyword(s):

Home Care ◽

Health Facility ◽

Response Rate ◽

Cross Sectional Study ◽

Care Group ◽

Cross Sectional ◽

Factors Associated ◽

Group Response ◽

Living Together ◽

Life Sustaining Treatment

Abstract Background: Recently, advance care planning (ACP) in palliative care has been attracting attention in Japan. The Japanese counterpart was established by the Ministry of Health, Labor and Welfare in November 2018. Moreover, discussions on end-of-life treatment are an important part of ACP It is suggested that individual feelings at the end-of-life are different; ACP depends on various situations. Decision making by patients themselves is recommended; however, there are cases where patients with dementia or other disorders cannot make decisions by themselves. Health providers may contact surrogates and consider their background for better ACP. We focused on patents’ families and examined factors related to the preferences of home caregivers’ and old-age health facility tenants’ families on patient ACP, including life-sustaining treatment (LST) at end-of-life.Methods: This cross-sectional study involved home caregivers’ and old-age health facility tenants’ families in Japan. We distributed 925 self-reported questionnaires comprising items such as number of people living together, comprehension of doctor’s explanations, nursing care level and duration, the Patient Health Questionnaire (PHQ)-9 and Short Form (SF)-8, and caregivers’ LST preference.Results: A valid response was obtained from 619 respondents [242 men and 377 women (309 in the home-care group, response rate = 61.1%; 310 in the facility-care group, response rate = 74.0%)]. The mean age of the respondents was 65.29 ± 12.09 years in the home-care group and 63.24 ± 10.39 years in the facility-care group. LST preference was significantly associated with sex, number of people living together, care duration, and comprehension of doctors’ explanations in the home-care group but was not significantly associated in the facility-care group. Furthermore, PHQ-9/SF-8 scores were not significantly associated with LST preference of the groups.Conclusions: Factors associated with decision on ACP differed between home caregivers’ families and health facility tenants’ families. In ACP, healthcare providers should be aware of the nature of each patient’s caregiving situation and living environment when discussing LST preference.

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2498. Perceptions of Injectable Antiretrovirals in an Urban HIV Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2176 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S866-S866

Author(s):

David E Koren ◽

Volodymyra Fedkiv ◽

Huaqing Zhao ◽

Robert Bettiker ◽

Ellen Tedaldi ◽

...

Keyword(s):

Response Rate ◽

Demographic Data ◽

Injection Site Reaction ◽

Cross Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Factors Associated ◽

Persons Living With Hiv ◽

Doctor's Office ◽

Living With Hiv

Abstract Background Although new injectable antiretrovirals (ARV) for HIV may soon be available, there is little research on patient preferences. We examined perceptions of injectable ARV among persons living with HIV (PLWH). Methods This cross-sectional study was conducted among PLWH presenting for an appointment at TempleHealth in Philadelphia, PA between March 11 and April 18, 2019. Respondents completed a self-administered survey comprising 29 questions about socio-demographic data, current ARV, and preferences regarding injectable ARV therapies. Responses were recorded on a 10-point Likert scale, on which responses in the 1–5 range were defined as unlikely and 6–10 range as likely to choose injectable ARV. The primary endpoint was to describe factors associated with likely vs. unlikely uptake of injectable ARV. Responses between groups were compared with Chi-square or Wilcoxon rank-sum tests. Results 171 patients completed a survey with a 56% response rate. Demographics were 60% male, 70% African American, 33% LGBQ-identifying, 2% transgender, with a mean age of 48 ± 13 years. Percentages of likely uptake (55%, n = 94) and unlikely uptake (45%, n = 77) were similar. Median likelihood was 7 (IQR 7–10) and varied from likely (10, IQR 8–10) and unlikely (1, IQR 1–5) cohorts. There were no differences in overall likelihood based on current number of pills or pill frequency (P > 0.05). A likelihood trend was found among patients who missed one or more doses per week, however current adherence was not significant (p = 0.06). Likelihood of uptake means increased as the frequency of administration decreased: 1-week (5.7 ± 3.7), 2-week (5.9 ± 3.7), 1-month (7.3 ± 3.5), 2-month (7.3 ± 3.6), and 3-month (7.7 ± 3.4). Likelihood of uptake decreased as duration of a potential injection site reaction increased: 1 day (6.2 ± 3.5), 2–3 days (4.6 ± 3.3), 4–6 days (3.6 ± 3.1), 7 days or longer (3.0 ± 3.2). Respondents preferred their doctor’s office (60%) over self-injection (23%), assisted injection at home (11%), pharmacy (4%), or special injection center (2%) for administration setting. Conclusion Our study indicates that availability of injectable administration has potential to find acceptance among PLWH. Disclosures All authors: No reported disclosures.

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Patients' and Nurses’ Experiences and Perceptions of Remote Monitoring of Implantable Cardiac Defibrillators in Heart Failure: Cross-Sectional, Descriptive, Mixed Methods Study

Journal of Medical Internet Research ◽

10.2196/19550 ◽

2020 ◽

Vol 22 (9) ◽

pp. e19550

Author(s):

Maria Liljeroos ◽

Ingela Thylén ◽

Anna Strömberg

Keyword(s):

Heart Failure ◽

Mixed Methods ◽

Response Rate ◽

Qualitative Content Analysis ◽

Implantable Cardioverter Defibrillators ◽

Cross Sectional ◽

Negative Experiences ◽

Positive Experiences ◽

The Mean ◽

Score Range

Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.

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