scholarly journals Patient-reported outcomes in symptom-driven remote arrhythmia monitoring: Evaluation of the Dutch HartWacht-telemonitoring program

2021 ◽  
Author(s):  
M Z H Kolk ◽  
S Blok ◽  
M C C De Wildt ◽  
F V Y Tjong ◽  
M M Winter ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Monitoring Program ◽  
Self Management ◽  
Control Group ◽  
Quantitative Evidence ◽  
Patient Reported ◽  
Related Quality ◽  
Physical Limitations ◽  
Disease Specific

Abstract Background There is limited quantitative evidence on the effect of symptom-driven telemonitoring for cardiac arrhythmias on patient-reported outcomes. We evaluated the effect of a symptom-driven remote arrhythmia monitoring program on the patient-reported health-related quality of life (HRQoL), sense of safety, physical limitations and self-management. Methods This was an observational retrospective longitudinal study of the symptom-driven HartWacht-telemonitoring program using a remote single-lead electrocardiogram (ECG) monitoring system. Real-world patient data from participants who were enrolled in the telemonitoring program for (suspected) symptomatic atrial fibrillation (AF) between July 2017 and September 2019 were evaluated. Primary outcomes were the patient-reported generic HRQoL, disease-specific HRQoL, sense of safety, physical limitations and self-management at date of enrolment, three months and six months of follow-up. Outcomes were compared to a historical control group consisting of AF patients receiving standard care. Results A total of 109 participants in the HartWacht-program (59 men (54%); mean age 61 ±11 years; 72% diagnosed AF) were included in complete case analysis. There was no significant change in HRQoL and sense of safety during follow-up. A significant improvement in the perceived physical limitations was observed. The level of self-management declined significantly during follow-up. Comparisons to the historic control group (n = 83) showed no difference between the patient-reported disease-specific HRQoL, sense of safety and physical limitations at six months follow-up. Conclusion Symptom-driven remote arrhythmia monitoring for AF does not seem to affect HRQoL and sense of safety, whereas the perceived physical limitations tend to improve. Patient-reported self-management declined during the first six months of participation.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

Moving from a ‘One Size Fits All’ to Personalized Follow-Up in Breast Cancer Survivors—Connecting Patient-Reported Outcomes with Economic Considerations

2019 ◽  
pp. 307-316
Author(s):  
Carmen Dirksen ◽  
Merel Kimman ◽  
Manuela Joore ◽  
Liesbeth Boersma
Keyword(s):  
Breast Cancer ◽  
Economic Evaluation ◽  
Patient Reported Outcomes ◽  
Care Delivery ◽  
Process Of Care ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related ◽  
Economic Considerations

Abstract: In the Netherlands, two studies were performed to investigate the effectiveness of several alternative follow-up strategies in terms of patient-reported outcomes (health-related quality of life and satisfaction), and to address economic considerations in breast cancer follow-up care. This chapter describes the economic evaluation of four follow-up strategies after breast cancer treatment. As such, it provides an example of the application of economic methods to evaluate the relative value of breast cancer care. Whereas economic evaluation is outcome-focused, the process of care delivery is also a major determinant of patient value. Insight into patients’ preferences for outcome and process is crucial in order to tailor care to individual patients’ needs. Therefore, in a second study, patients’ preferences for the process of care delivery were evaluated.

Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

2020 ◽  
Vol 48 (10) ◽  
pp. 2471-2480 ◽  
Author(s):  
Claudia R. Brick ◽  
Catherine J. Bacon ◽  
Matthew J. Brick
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Control Group ◽  
Total Hip ◽  
Patient Reported ◽  
Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

scholarly journals Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882283 ◽  
Author(s):  
Ajay C. Lall ◽  
Jon E. Hammarstedt ◽  
Asheesh G. Gupta ◽  
Joseph R. Laseter ◽  
Mitchell R. Mohr ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Smoking Status ◽  
Arthroscopic Surgery ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Patient Reported ◽  
Smoking Group

Background: The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers. Purpose/Hypothesis: The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05. Results: A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group ( P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups. Conclusion: Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.

Clinical Outcomes and Reoperation Rates After Hip Arthroscopy in Female Athletes With Low Versus Normal Body Mass Index: A Propensity-Matched Comparison With Minimum 2-Year Follow-up

2021 ◽  
pp. 036354652110551
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
Jade S. Owens ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Female Athletes ◽  
Control Group ◽  
Return To Sports ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Low Bmi ◽  
High Level

Background: The effect of low body mass index (BMI) on outcomes in female athletes is unknown. Purpose: (1) To report minimum 2-year patient-reported outcomes and return to sports for high-level female athletes with low BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare results with those of a propensity-matched control group of high-level female athletes with a normal BMI. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all professional, collegiate, and high school female athletes who had a low BMI and underwent primary hip arthroscopy between September 2009 and March 2017 at our institute. Return-to-sports status and minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched to high-level female athletes with a normal BMI for comparison. Results: A total of 21 high-level female athletes (25 hips) with a mean ± SD follow-up of 58.9 ± 31.5 months were included. They demonstrated significant improvement from preoperatively to latest follow-up for the mHHS, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and VAS ( P < .001). When outcomes were compared with those of the control group, female athletes with low BMI demonstrated lower rates of achieving the MCID for the mHHS (54.5% vs 77.4%; P = .041), PASS for the International Hip Outcome Tool–12 (45.5% vs 72.6%; P = .022), and MOIST for the VAS (31.8% vs 56.5%; P = .047). There were no other significant differences in the rate of achieving the MCID, PASS, or MOIST between the groups ( P > .05). Female athletes with low BMI also had higher rates of revision when compared with the control group (27.2% vs 10.6%; P = .049), but there were comparable return-to-sports rates (75.0% vs 74.5%; P > .05). Conclusion: High-level female athletes with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes and acceptable rates of return to play. When compared with a control group with normal BMI, they exhibited higher rates of revision and lower rates of achieving the MCID for the mHHS, PASS for the International Hip Outcome Tool–12, and MOIST for the VAS.

Longitudinal Clinical and Patient-Reported Outcomes After Transversus Abdominis Release for Complex Hernia Repair With a Review of the Literature

2021 ◽  
pp. 000313482110385
Author(s):  
Adrienne N. Christopher ◽  
Martin P. Morris ◽  
Louis-Xavier Barrette ◽  
Viren Patel ◽  
Robyn B. Broach ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Patient Reported Outcomes ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Fascial Closure ◽  
Review Of The Literature ◽  
Transversus Abdominis Release ◽  
Patient Reported ◽  
Disease Specific

Purpose Posterior component separation with transversus abdominis release (TAR) enables medial myofascial flap advancement in complex abdominal wall reconstruction. Here, we add to a growing body of literature on TAR by assessing longitudinal clinical and patient-reported outcomes (PROs) after complex ventral hernia repair (VHR) with TAR. Methods Adult patients undergoing VHR with TAR between 10/15/2015 and 1/15/2020 were retrospectively identified. Patients with parastomal hernias and <12 months of follow-up were excluded. Clinical outcomes and PROs were assessed. Results Fifty-six patients were included with a median age and body mass index of 60 and 30.8 kg/m2, respectively. The average hernia defect was 384 cm2 [IQR 205-471], and all patients had retromuscular mesh placed. The most common complications were delayed healing (19.6%) and seroma (14.3%). There were no cases of mesh infection or explantation. Previous hernia repair and concurrent panniculectomy were risk factors for developing complications ( P < .05). One patient (1.8%) recurred at a median follow-up of 25.2 months [IQR 18.2-42.4]. Significant improvement in disease-specific PROs was maintained throughout the follow-up period (before to after P < .05). Conclusion Transversus abdominis release is a safe and efficacious technique to achieve fascial closure and retromuscular mesh in the repair of complex hernia defects.

Patient-reported outcomes following primary total hip arthroplasty in Crowe type Ⅲ or Ⅳ developmental dysplasia are comparable to those in Crowe type Ⅰ: a case-control study of 96 hips with intermediate-term follow-up

2020 ◽  
Author(s):  
Ken Ueoka ◽  
Tamon Kabata ◽  
Yoshitomo Kajino ◽  
Daisuke Inoue ◽  
Takaaki Ohmori ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Case Control Study ◽  
Control Group ◽  
Type I ◽  
Sf 36 ◽  
Shortening Osteotomy ◽  
Patient Reported ◽  
Femoral Shortening ◽  
Control Study

Abstract Background: A few previous studies have investigated patient satisfaction following total hip arthroplasty (THA) according to the degree of pelvic deformity. This study compared patient-reported outcomes following primary THA for Crowe types Ⅲ, Ⅳ and I dysplasia.Methods: This was the retrospective case-control study assessed patients who underwent primary THA by a single surgeon at a single institution from 2008 to 2016. We sent postal questionnaires to 38 patients with Crowe type III and IV dysplasia. Among the questionnaire respondents, 23 patients, excluding cases with a follow-up period of less than 1 year, were enrolled as the H group. The control group included 46 patients with Crowe type I, matched for sex, age, body mass index and surgical approach. To investigate the influence of femoral shortening osteotomy, the H group was divided according to whether or not femoral shortening osteotomy was performed. Ten patients underwent THA with femoral shortening osteotomy (FO group), while 12 patients underwent THA without femoral shortening osteotomy (N-FO group). Patient demographics, average follow-up period, surgical information, pre- and postoperative leg length discrepancy (LLD), and perioperative complications were investigated. Clinical evaluations were performed using the Japanese Orthopaedic Association (JOA) scores, 36-item short-form survey (SF-36), net promotor score (NPS), visual analogue scale (VAS), and questionnaires. The VAS and SF-36 was acquired at only final follow-up. Results: The H and control groups were not significantly different in the postoperative JOA scores and SF-36. In the H group, VAS at the final follow-up was significantly higher, and significantly more patients felt that postoperative rehabilitation was serious, expressing that they underwent THA for LLD correction. Additionally, VAS in the FO group was higher than those in the N-FO group. Postoperative LLD was significantly greater in the H group than in the control group. Each group had the NPS of over 50.Conclusion: The postoperative VAS was higher in Crowe type Ⅲ and Ⅳ dysplasia than in Crowe type I dysplasia, but there were no significant differences in the postoperative satisfaction, JOA score and SF-36. The findings may help explain the effects of THA preoperatively to patients with Crowe type Ⅲ and Ⅳ dysplasia.Level of Evidence: Therapeutic Level 3b

scholarly journals Assessment of Patient-Reported Outcomes After Polytrauma: A Systematic Review

2020 ◽  
Author(s):  
Michaela Ritschel ◽  
Silke Kuske ◽  
Irmela Gnass ◽  
Silke Andrich ◽  
Kai Moschinski ◽  
...  
Keyword(s):  
Social Participation ◽  
Patient Reported Outcomes ◽  
Short Form ◽  
Data Extraction ◽  
Postal Survey ◽  
Study Results ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related

Abstract Background: Tools assessing patient-reported outcomes (PROs) after polytrauma have not been systematically reviewed so far. Therefore, we sought to: (1) collect instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL), and social participation during follow-up after polytrauma, (2) describe their use (e.g. frequency of application during follow-up), and (3) investigate other relevant PROs assessed in the included studies (e.g. pain, depression, anxiety).Methods: The search was conducted in MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, the trials registers ClinicalTrials.gov, and WHO ICTRP. All original empirical research published between January 2005 and April 2018 was included. Data extraction, narrative content analysis, and a critical appraisal were performed.Results: The search yielded 3496 hits and 54 publications were included in the review. Predominantly, HRQoL was assessed (in 48 of 54 publications), with Short Form-36 Health Survey (SF-36) applied most frequently. ADL and (social) participation were rarely assessed. The follow-up period lasted between 8 days and 17.5 years; assessments were performed between one and five times. Most used were a single assessment of PROs, a follow-up period of 1 to 1.5 years, and a postal survey. Other relevant PRO areas reported were function, mental disorders, and pain.Conclusions: There is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but further harmonisation between central players, such as trauma registers, is required. Definition and continuous collection of core outcome sets would improve comparability of study results, creating the basis for more targeted treatment. Additional knowledge on rarely reported PRO areas like (social) participation and social network may lead to their consideration in health services provision.Registration: PROSPERO (CRD42017060825)

Phase III non-randomized controlled trial of PROMPT-Care, an eHealth intervention utilizing patient reported outcomes in routine clinical care: Impact on emergency department presentations.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6510-6510 ◽  
Author(s):  
Afaf Girgis ◽  
Ivana Durcinoska ◽  
Anthony Arnold ◽  
Nasreen Kaadan ◽  
Andrew Alexis Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Controlled Trial ◽  
Phase Iii ◽  
Control Group ◽  
Diverse Population ◽  
Patient Reported ◽  
The Impact

6510 Background: The significant impact of routine assessment and clinical utilization of patient-reported outcomes (PRO) on patient and survival outcomes and reduced emergency department (ED) presentations has been demonstrated in specific patient populations (e.g. advanced cancer). This controlled trial evaluated the impact of an eHealth system, PROMPT-Care, on ED presentations in a diverse population of cancer patients from four oncology treatments centers. Methods: All adult patients receiving cancer care (including adjuvant therapy and follow-up) were eligible, excepting those with a diagnosis of a hematological malignancy, insufficient English literacy or no internet access outside of the clinic. Intervention (PROMPT-Care) patients completed monthly online assessments comprising 61 items of distress, common symptoms and unmet needs, with PRO results electronically transferred into the electronic medical record (EMR). In “real-time”, the care team accessed patients’ PRO summary reports to guide their care, an email alert notified nurses of ongoing unresolved issues between visits, and patients received links to support self-management. Control group patients (n = 2,288) comprised the general cancer patient population receiving usual care at the participating cancer therapy centers. Multivariable negative binomial regression was used to compare between-group differences. Results: From April 2016 to March 2018, 345 eligible patients (mean age 62, 58% female, 27% stage IV) participated and were sent at least four assessments within the first six months on trial. On average, control patients had 30 ED presentations and PROMPT-Care patients had 21 ED presentations per 10,000 patient days. After adjusting for age, sex and stage of disease, PROMPT-Care patients had 26% (95% CI 0.2%, 57%) fewer ED presentations compared to the control group (p = 0.0483). Conclusions: The PROMPT-Care intervention resulted in significantly fewer ED presentations in a broad population of cancer patients, including those currently undergoing cancer treatment or are in follow-up, and patients with a wide range of tumor types. The results support its utility as an improved model for ongoing supportive care for a diverse population, with potential healthcare cost savings. Clinical trial information: ACTRN12616000615482.

Sign in / Sign up

Export Citation Format

Share Document