scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028122
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Tamara Metzler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Clinical Test ◽  
Output Response ◽  
Diagnostic Technology ◽  
Response To Stress ◽  
Barriers To Implementation

ObjectiveTo explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.DesignQualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach.SettingNewcastle upon Tyne, UK.ParticipantsFourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists).ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703421
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Luke Vale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Clinical Test ◽  
Output Response ◽  
Response To Stress

BackgroundPrimary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.AimTo determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.MethodQualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.

Reproducibility of a simple cardiac output response to stress test to diagnose and monitor heart failure in a primary care setting

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697109
Author(s):  
Djordje Jakovljevic ◽  
Sarah J Charman ◽  
Nduka C Okwose ◽  
Renae J Stefanetti ◽  
Kristian Bailey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Stress Test ◽  
Standing Position ◽  
Output Response ◽  
Non Invasive ◽  
Response To Stress ◽  
One Step ◽  
Lower Limits

BackgroundWe developed a simple non-invasive Cardiac Output Response to Stress (CORS) Test to improve diagnosis and monitoring of heart failure in primary care.AimThe aim of the present study was to assess test-retest reproducibility of the CORS test.MethodThirty-two healthy volunteers (age, 64±10, female n=18) were recruited. Cardiac output was measured continuously using bioreactance method in supine and standing position, and during a two 3-min stages of a step-exercise protocol (10 and 15 steps per minute) using a 15-cm height bench. The CORS test was performed twice i.e. Test 1 and Test 2.ResultsCardiac output and stroke volume were not significantly different between the two tests at supine (6.2±1.4 versus 6.3±1.7 L/min, P = 0.84; 102±24 versus 108±32 ml/beat, P = 0.36), standing (5.7±2.1 versus 5.7±1.9 L/min, P = 0.99; 82±32 versus 83±29 ml/beat, P = 0.93), stage one step-exercise (8.5± 1.8 versus 8.2±1.9 L/min, P = 0.56; 104±26 versus 104±27 ml/beat, P = 0.99) and stage two step-exercise (9.9±1.7 versus 9.6±2.0 L/min, P = 0.51; 109±29 versus 111±26 ml/beat, P = 0.76). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r=0.92, P<0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (−1.9 to 2.1) L/min, combining rest and exercise data.ConclusionThe CORS test demonstrates acceptable reproducibility and can potentially be used in primary care to identify and monitor heart failure.

scholarly journals A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

2018 ◽  
Vol 5 (4) ◽  
pp. 703-712 ◽  
Author(s):  
Sarah J. Charman ◽  
Nduka C. Okwose ◽  
Renae J. Stefanetti ◽  
Kristian Bailey ◽  
Jane Skinner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Stress Test ◽  
Output Response ◽  
Response To Stress

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

Cardiac Output Response to Continuous Positive Airway Pressure in Congestive Heart Failure

1992 ◽  
Vol 145 (2_pt_1) ◽  
pp. 377-382 ◽  
Author(s):  
T. Douglas Bradley ◽  
Richard M. Holloway ◽  
Peter R. McLaughlin ◽  
Bette L. Ross ◽  
Janice Walters ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Output ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Output Response

scholarly journals Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020521 ◽  
Author(s):  
Anne-Marie Burn ◽  
Jane Fleming ◽  
Carol Brayne ◽  
Chris Fox ◽  
Frances Bunn
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Hospital Staff ◽  
Case Finding ◽  
Care Staff ◽  
Dementia Case ◽  
Primary Care Staff ◽  
Views Of Healthcare Professionals

ObjectivesIn 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.DesignQualitative study involving interviews, focus groups and thematic content analysis.SettingPrimary care and secondary care across six counties in the East of England.ParticipantsHospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.ResultsWe recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.ConclusionsThe study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.

scholarly journals Knowledge Translation in Heart Failure

2020 ◽  
Vol 15 (SP1) ◽  
pp. 27-35
Author(s):  
Darshan H. Brahmbhatt ◽  
Jeremy Kobulnik
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Knowledge Translation ◽  
Models Of Care ◽  
Heart Failure Patients ◽  
New Therapies ◽  
The Past ◽  
Large Numbers ◽  
Barriers To Implementation

The treatment of heart failure has expanded over the past three decades with large numbers of new medications and healthcare innovations available for these patients. At the same time, the prevalence of heart failure continues to increase across Canada and these patients are managed by a variety of clinicians from differing backgrounds in both primary care and hospital settings. Despite national recommendations advocating uptake of these new therapies, their utilization remains limited and inconsistent across the country. This review discusses the importance of knowledge translation in heart failure and examines the barriers to implementation of new therapies and models of care, providing a range of solutions to facilitate the delivery of guideline-directed care for heart failure patients.

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