Abstract 057: Beyond Convenience: Video Visits Can Increase The Efficiency Of Preventive Care Delivery

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Neil M Kalwani ◽  
Katherine M Wang ◽  
Jahnavi Deb ◽  
Thomas Gold ◽  
Akhil Maddukuri ◽  
...  
Keyword(s):  
South Asian ◽  
Cardiometabolic Risk ◽  
Care Delivery ◽  
Preventive Cardiology ◽  
Level Data ◽  
Cardiology Clinic ◽  
Care Practices ◽  
Time Required ◽  
Operational Impacts

Introduction: In response to the COVID-19 pandemic, medical practices have expanded utilization of telehealth. Little is known about the operational impacts of transitioning from in-person to video visits in specialty clinics. In 2018, the Stanford South Asian Translational Heart Initiative (SSATHI), a preventive cardiology clinic focused on high-risk South Asian adults, introduced CardioClick, a program replacing in-person follow-up visits with video visits. Hypothesis: We hypothesized that implementation of video visits increased the efficiency of clinic operations. Methods: We extracted visit-level data from the EHR for 134 patients enrolled in CardioClick with video follow-up visits from June 14, 2018 to April 21, 2020 and a cohort of 276 patients enrolled in the in-person SSATHI prevention program with follow-up visits from September 11, 2014 to March 6, 2020. Results: Patients in CardioClick and the in-person cohort were similar in terms of age (mean 45 years), gender balance (23 vs 21% female), and cardiometabolic risk profiles. There were 181 video and 637 in-person follow-up visits. Video visits were shorter than in-person visits, both in terms of total clinic time [median 22 min (IQR 16, 29) vs 67 min (48, 100)] and provider time required [median 22 min (IQR 16, 29) vs 30 min (12, 58)]. Video visits were more likely to end on time (71 vs 11%, p<0.001). The median video visit ended on time while the median in-person visit ended 32 min late (13, 70) (see Figure). Providers were also more likely to complete video visit documentation the same day (56 vs 42%, p=0.001). Conclusions: In a preventive cardiology clinic, video follow-up visits required less clinic and provider time than in-person visits, were more likely to end on time, and were associated with increased same-day provider documentation completion. In conclusion, video visits offer benefits beyond their convenience and may increase the operational efficiency of specialty care practices focused on disease prevention, improving value in care delivery.

Abstract P100: Improving Ideal Cardiovascular Health in a Pediatric Preventive Cardiology Practice

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Holly C Gooding ◽  
Kimberlee Gauvreau ◽  
Jennifer Bachman ◽  
Annette Baker ◽  
Skylar Griggs ◽  
...  
Keyword(s):  
Cardiovascular Health ◽  
Dietary Habits ◽  
Smoking Status ◽  
Clinical Care ◽  
Pediatric Care ◽  
Initial Assessment ◽  
Ideal Cardiovascular Health ◽  
Preventive Cardiology ◽  
Cardiology Clinic

Introduction: Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and individual interventions. Hypothesis: We hypothesized that children referred to a multidisciplinary preventive cardiology clinic would demonstrate improved iCVH after clinic-based lifestyle counseling. Methods: We analyzed data from youth ages 8-19 years seen for ≥2 consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2017. Demographic information, smoking status, diet, and physical activity were self-reported. Anthropometric data, blood pressure, fasting cholesterol, and fasting glucose were measured using standard protocols. We applied AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations to data extracted from a clinical registry. Each iCVH metric had a possible range of 0 (poor) to 2 (ideal); the total iCVH score could range from 0 (all poor) to 14 (all ideal). Results: Median age of the 767 children in the study was 12.5 years [IQR 10.2,15.9]; 414 (54%) were female and 32 (5%) had a moderate or high CVD risk condition (diabetes, renal disease, Kawasaki, congenital heart disease, or heart transplant). Over a median of 3.9 [IQR 3.2, 6.0] months from initial assessment to first follow-up, mean iCVH score improved from 7.7 (SD 2.2) to 8.1 (SD 2.2) (p < 0.001). Females had higher iCVH scores at baseline and follow-up (females 7.9 to 8.4 vs. males 7.5 to 7.9, p<0.001), as did children younger than 14 years of age (data not shown). iCVH score improved to a mean of 8.3 (SD 2.4) for the 449 children returning for a third visit. The largest improvement was observed in total cholesterol and dietary habits (Figure); only 61 (8%) of children were prescribed statin therapy. Conclusion: Multidisciplinary clinical care can improve the iCVH of children who present with non-optimal levels, largely without the use of medications. Further work is needed to determine the scalability and long-term effectiveness of cardiovascular health promotion efforts in pediatric care.

scholarly journals Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study

JMIR Cardio ◽  
10.2196/28246 ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. e28246
Author(s):  
Neil M Kalwani ◽  
Austin N Johnson ◽  
Vijaya Parameswaran ◽  
Rajesh Dash ◽  
Fatima Rodriguez
Keyword(s):  
Risk Factors ◽  
South Asian ◽  
Patient Engagement ◽  
Prevention Program ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Preventive Cardiology ◽  
Asian Patients ◽  
Cardiology Clinic ◽  
Cvd Prevention

Background Telehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention. Objective The objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program. Methods In 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic. Results In this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic’s CVD prevention program (76/118, 64.4% vs 173/441, 39.2%, respectively; P<.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; P<.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort. Conclusions Telehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics.

Abstract 16217: Culturally-tailored Team-based Preventive Cardiology Program Improves Cardiovascular Risk for South Asian Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Keon Pearson ◽  
Vijaya Parameswaran ◽  
Destini Gibbs-Curtis ◽  
Austin Johnson ◽  
Kiranbir Josan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Cholesterol ◽  
South Asian ◽  
South Asians ◽  
Clinical Intervention ◽  
High Sensitivity ◽  
Initial Assessment ◽  
Preventive Cardiology ◽  
Culturally Tailored

Introduction: South Asians (SA) have a two times greater prevalence of CAD and metabolic syndrome (MetS) than matched Europeans. Diet and physical activity may be best addressed through culturally-tailored interventions. The Stanford South Asian Translational Heart Initiative (SSATHI) was designed to help SA better understand and improve their risk factors. We tested the hypothesis that a team-based and culturally-tailored clinical intervention for SA would result in a reduction in MetS risk factors. Methods: Patients underwent an initial assessment consisting of fasting lipid profile, advanced lipid studies (lipid fractionation, lp (a), apoA1, apoB), inflammatory markers (high sensitivity CRP, homocysteine), and A1c. All non-diabetics underwent two-hour OGTT. Following initial assessment by a cardiologist, a registered dietician developed a personalized nutrition plan based on SA cuisine. Results: A total of 395 patients were seen between July, 2011 and July, 2019. Of these, 198 (50%) completed at least two cardiologist visits with baseline and follow up labs. Patients had an average age of 45.5 years and 86% were male. At baseline, SSATHI patients had a mean BMI of 26.4 (IQR = 23.9-28.8), 52% of patients had total cholesterol greater than 190 mg/dl, 21% had systolic BP > 140 mmHg, and 13% had diastolic BP > 90 mmHg. During an average follow-up of 11.8 ± 9.2 months, diastolic BP declined from 80.9 ± 9.32 to 78.9 ± 7.6 mmHg (p = 0.028), total cholesterol decreased from 190.4 ± 46.4 to 153.4 ± 63.7 mg/dl (p < 0.001), total triglycerides declined from 137.1 ± 87.1 to 100.2 ± 67.5 mg/dl (p < 0.001), and LDL declined from 120.4 ± 40.0 to 92.3 ± 46.4 mg/dl (p <0.001). HDL declined from 49.0 ± 15.4 to 44.5 ± 19.8 mg/dl (p = 0.022). ASCVD and A1c were not significantly different. Conclusion: A team-based and culturally-informed program targeted to South Asian populations may help improve cardiometabolic risk factors but may be limited by program attrition and generalizability.

scholarly journals Vaginal Delivery: A Day-Care Procedure with the use of Day-Care Delivery Protocol

2013 ◽  
Vol 5 (3) ◽  
pp. 158-160
Author(s):  
Shruti Malvi ◽  
Savita Mishra
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
South Asian ◽  
Day Care ◽  
Perinatal Outcome ◽  
Care Delivery ◽  
Close Monitoring ◽  
Care Procedure ◽  
Delivery Protocol

ABSTRACT Objectives To know the feasibility of safe activation and augmentation of labor with close monitoring leading to favorable fetomaternal outcome, as a day-care procedure using the daycare delivery (DCD) protocol. Materials and methods Inclusion of a select subset of 304 primi women at term was done for labor activation and augmentation, in a closely monitored fashion, followed by assessment of outcomes and follow-up. Results Almost 70% of the selected primi women delivered vaginally within the stipulated time of 12 to 15 hours and only 18% needed cesarean section. No perinatal mortality was observed. Conclusion Day-care delivery may prove to be a suitable option to the parturient and her obstetrician ensuring quality labor and optimal perinatal outcome. How to cite this article Malvi S, Mishra S. Vaginal Delivery: A Day-Care Procedure with the use of Day-Care Delivery Protocol. J South Asian Feder Obst Gynae 2013;5(3):158-160.

scholarly journals Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study (Preprint)

2021 ◽  
Author(s):  
Neil M Kalwani ◽  
Austin N Johnson ◽  
Vijaya Parameswaran ◽  
Rajesh Dash ◽  
Fatima Rodriguez
Keyword(s):  
Risk Factors ◽  
South Asian ◽  
Patient Engagement ◽  
Prevention Program ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Preventive Cardiology ◽  
Asian Patients ◽  
Cardiology Clinic ◽  
Cvd Prevention

BACKGROUND Telehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention. OBJECTIVE The objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program. METHODS In 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic. RESULTS In this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic’s CVD prevention program (76/118, 64.4% vs 173/441, 39.2%, respectively; <i>P</i>&lt;.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; <i>P</i>&lt;.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort. CONCLUSIONS Telehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics.

WoundClot® Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation

2021 ◽  
pp. 1-7
Author(s):  
Orit Kliuk-Ben Bassat ◽  
Doron Schwartz ◽  
Alexander Zubkov ◽  
Amir Gal-Oz ◽  
Alexander Gorevoy ◽  
...  
Keyword(s):  
Bleeding Time ◽  
Control Group ◽  
Dialysis Adequacy ◽  
Cotton Gauze ◽  
Single Center Study ◽  
Time Required ◽  
Venous Fistula ◽  
Thrombosis Rate

<b><i>Introduction:</i></b> Decannulation of the arteriovenous fistula (AVF) after each hemodialysis session requires a precise compression on the needle puncture site. The objective of our study was to evaluate the bleeding time (BT) needed to achieve hemostasis using WoundClot, an innovative hemostatic gauze, and to assess whether its long-term use can improve AVF preservation. <b><i>Methods:</i></b> This is a prospective single center study. Initially, the time to hemostasis after AVF decannulation was compared between WoundClot and cotton gauze in 24 prevalent hemodialysis patients. Thereafter, the patients continued to use WoundClot for 12 months and were compared to a control group consisting of 25 patients using regular cotton gauze. Follow-up data included parameters of dialysis adequacy, AVF interventions, and thrombotic events. <b><i>Results:</i></b> WoundClot use shortened significantly the time needed for hemostasis. Mean venous BT decreased by 3.99 (±4.6) min and mean arterial BT by 6.38 (±4.8) min when using WoundClot compared to cotton gauze (<i>p</i> &#x3c; 0.001). At the end of the study, dialysis adequacy expressed by spKt/V was higher in the WoundClot group compared to control (1.73 vs. 1.53, respectively, <i>p</i> = 0.047). Although patients in WoundClot group had a higher baseline BT, arterial and venous pressures did not differ between the groups after a median follow up of 10.8 months. AVF thrombosis rate was similar between the groups. <b><i>Conclusions:</i></b> WoundClot hemostatic gauze significantly reduced the time required for hemostasis after AVF decannulation and may be associated with better AVF preservation. We suggest using WoundClot for arterial BT longer than 15 min and for venous BT longer than 12.5 min.

scholarly journals Exoplanet mass estimation for a sample of targets for the Ariel mission

2021 ◽  
Author(s):  
J. R. Barnes ◽  
C. A. Haswell
Keyword(s):  
Radial Velocity ◽  
Input Parameter ◽  
Noise Sources ◽  
Time Commitment ◽  
Low Mass ◽  
Time Required ◽  
Fixed Input ◽  
The Impact ◽  
Quadrature Sampling

AbstractAriel’s ambitious goal to survey a quarter of known exoplanets will transform our knowledge of planetary atmospheres. Masses measured directly with the radial velocity technique are essential for well determined planetary bulk properties. Radial velocity masses will provide important checks of masses derived from atmospheric fits or alternatively can be treated as a fixed input parameter to reduce possible degeneracies in atmospheric retrievals. We quantify the impact of stellar activity on planet mass recovery for the Ariel mission sample using Sun-like spot models scaled for active stars combined with other noise sources. Planets with necessarily well-determined ephemerides will be selected for characterisation with Ariel. With this prior requirement, we simulate the derived planet mass precision as a function of the number of observations for a prospective sample of Ariel targets. We find that quadrature sampling can significantly reduce the time commitment required for follow-up RVs, and is most effective when the planetary RV signature is larger than the RV noise. For a typical radial velocity instrument operating on a 4 m class telescope and achieving 1 m s−1 precision, between ~17% and ~ 37% of the time commitment is spent on the 7% of planets with mass Mp < 10 M⊕. In many low activity cases, the time required is limited by asteroseismic and photon noise. For low mass or faint systems, we can recover masses with the same precision up to ~3 times more quickly with an instrumental precision of ~10 cm s−1.

scholarly journals PUTRA-Adol study: protocol for an observational follow-up study to assess the tracking of dietary patterns linked to cardiometabolic risk factors and its prospective relationship with non-alcoholic fatty liver disease, carotid intima-medial thickness and mental well-being during adolescence in Malaysia

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044747
Author(s):  
Geeta Appannah ◽  
Nor Aishah Emi ◽  
Mugambikai Magendiran ◽  
Zalilah Mohd Shariff ◽  
Azriyanti Anuar Zaini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiometabolic Risk ◽  
Well Being ◽  
Cardiometabolic Risk Factors ◽  
Dietary Intakes ◽  
Alcoholic Fatty Liver ◽  
Follow Up Study ◽  
Carotid Intima Medial Thickness ◽  
Mental Well Being

IntroductionGrowing evidence suggesting that dietary intakes of adolescents are generally of poor quality but not adequately assessed in relation to the early manifestation of non-communicable diseases. This study aimed; (1) to examine tracking of an empirical dietary pattern (DP) linked to cardiometabolic risk factors and, (2) to assess prospective relationships between a DP characterised by high intakes of dietary energy density (DED) and added sugar, and cardiometabolic risk factors, non-alcoholic fatty liver disease (NAFLD), carotid intima-medial thickness (CIMT) and mental well-being during adolescence.Methods and analysisThe PUTRA-Adol is a prospective follow-up study that builds up from 933 Malaysian adolescents who were initially recruited from three southern states in Peninsular Malaysia in 2016 (aged 13 years then). Two sessions are planned; the first session will involve the collection of socio-economy, physical activity, dietary intakes, mental well-being, body image, risk taking behaviour, sun exposure, family functioning and menstrual (in women) information. The second session of data collection will be focused on direct assessments such as venesection for blood biochemistry, anthropometry and ultrasonography imaging of liver and bilateral carotid arteries. Z-scores for an empirical DP will be identified at 16 years using reduced rank regression. Multilevel modelling will be conducted to assess the tracking of DP and prospective analysis between the DP, cardiometabolic health, NAFLD, CIMT and mental well-being.Ethics and disseminationEthical approval for the conduct of this follow-up study was obtained from the Universiti Putra Malaysia’s Ethics Committee for Research Involving Human Subjects (JKEUPM) (Reference number: JKEUPM-2019–267). The findings from this study will be disseminated in conferences and peer-reviewed journals.DiscussionThe findings gathered from this study will provide evidence on prospective relationships between DPs, cardiometabolic risk factors, NAFLD, early atherosclerosis and mental well-being and that it may be mediated particularly DED and added sugar during adolescence.

scholarly journals Participant education, spousal education and dementia risk in a diverse cohort of members of an integrated health care delivery system in Northern California

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e040233
Author(s):  
Paola Gilsanz ◽  
Elizabeth Rose Mayeda ◽  
Chloe W Eng ◽  
Oanh L Meyer ◽  
M Maria Glymour ◽  
...  
Keyword(s):  
Care Delivery ◽  
Health Indicators ◽  
Health Care Delivery System ◽  
College Degree ◽  
Dementia Risk ◽  
Education College ◽  
Race Ethnicity ◽  
Participant Education ◽  
Spousal Education

ObjectiveThe role of spousal education on dementia risk and how it may differ by gender or race/ethnicity is unknown. This study examines the association between one’s own education separate from and in conjunction with spousal education and risk of dementia.DesignCohort.SettingKaiser Permanente Northern California (KPNC), an integrated health care delivery system.Participants8835 members of KPNC who were aged 40–55, married and reported own and spousal education in 1964–1973.Primary outcome measureDementia cases were identified through medical records from 1 January 1996 to 30 September 2017.MethodsOwn and spousal education was self-reported in 1964–1973 and each was classified as four indicator variables (≤high school, trade school/some college, college degree and postgraduate) and as ≥college degree versus <college degree. Age as timescale weighted Cox proportional hazard models adjusted for demographics and health indicators evaluated associations between participant education, spousal education and dementia risk overall and by gender and race/ethnicity.ResultsThe cohort was 37% non-white, 46% men and 30% were diagnosed with dementia during follow-up from 1996 to 2017 (mean follow-up=12.7 years). Greater participant education was associated with lower dementia risk independent of spousal education, demographics and health indicators. Greater spousal education was associated with lower dementia adjusting for demographics but became non-significant after further adjustment for participant education. The same pattern was seen for spousal education ≥college degree (not adjusting for participant education HRspousal education≥college degree=0.83 (95% CI: 0.76 to 0.90); adjusting for participant education HRspousal education≥college degree=0.92 (95% CI: 0.83 to 1.01)). These associations did not vary by gender or race/ethnicity.ConclusionIn a large diverse cohort, we found that higher levels of participant’s own education were associated with lower dementia risk regardless of spousal education. An inverse association between spousal education and dementia risk was also present, however, the effects became non-significant after adjusting for participant education.

scholarly journals Replication study reveals miR-483-5p as an important target in prevention of cardiometabolic disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Widet Gallo ◽  
Filip Ottosson ◽  
Cecilia Kennbäck ◽  
Amra Jujic ◽  
Jonathan Lou S. Esguerra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cardiometabolic Risk ◽  
Carotid Atherosclerosis ◽  
Tissue Injury ◽  
Control Sample ◽  
Cardiometabolic Risk Factors ◽  
Cardiometabolic Disease ◽  
Micro Rnas

Abstract Background Alterations in levels of circulating micro-RNAs might reflect within organ signaling or subclinical tissue injury that is linked to risk of diabetes and cardiovascular risk. We previously found that serum levels of miR-483-5p is correlated with cardiometabolic risk factors and incidence of cardiometabolic disease in a case–control sample from the populations-based Malmö Diet and Cancer Study Cardiovascular Cohort (MDC-CC). We here aimed at replicating these findings and to test for association with carotid atherosclerosis. Methods We measured miR-483-5p in fasting serum of 1223 healthy subjects from the baseline examination of the population-based, prospective cohort study Malmö Offspring Study (MOS) and correlated miR-483-5p to cardiometabolic risk factors and to incidence of diabetes mellitus and coronary artery disease (CAD) during 3.7 (± 1.3) years of follow-up using logistic regression. In both MOS and MDC-CC we related mir-483-5p to carotid atherosclerosis measured with ultrasound. Results In cross-sectional analysis miR-483-5p was correlated with BMI, waist circumference, HDL, and sex. After adjustment for age and sex, the association remained significant for all risk factors except for HDL. Logistic regression analysis showed significant associations between miR-483-5p and new-onset diabetes (OR = 1.94, 95% CI 1.06–3.56, p = 0.032) and cardiovascular disease (OR = 1.99, 95% CI 1.06–3.75, p = 0.033) during 3.7 (± 1.3) years of follow-up. Furthermore, miR-483-5p was significantly related with maximum intima-media thickness of the carotid bulb in MDC-CC (p = 0.001), but not in MOS, whereas it was associated with increasing number of plaques in MOS (p = 0.007). Conclusion miR-483-5p is related to an unfavorable cardiometabolic risk factor profile and predicts diabetes and CAD, possibly through an effect on atherosclerosis. Our results encourage further studies of possible underlying mechanisms and means of modifying miR-483-5p as a possible interventional target in prevention of cardiometabolic disease.

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