Towards a comprehensive telecardiology monitoring centre for community-based services

In a pilot study of primary-care telecardiology, 2563 consultations were carried out over 18 months. Following teleconsultation, 2076 patients (81%) were found to be suitable for management entirely by the general practitioner, without the need for referral to hospital. The system identified 487 patients (19%) with cardiac problems who required either admission to hospital or outpatient assessment. There was a resultant saving of referrals to hospital accident and emergency departments. Extension of the telecardiology service to include tele-echocardiography may result in faster access to diagnosis and better management of patients in heart failure, improving patients’ quality of life and reducing hospitalization.

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Acceptability, Feasibility and Preliminary Evaluation of a Novel, Personalised, Home-Based Physical Activity Intervention for Chronic Heart Failure (Active-at-Home-HF): a Pilot Study

Sports Medicine - Open ◽

10.1186/s40798-019-0216-x ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 2

Author(s):

Nduka C. Okwose ◽

Leah Avery ◽

Nicola O’Brien ◽

Sophie Cassidy ◽

Sarah J. Charman ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Heart Failure ◽

Pilot Study ◽

Chronic Heart Failure ◽

Physical Activity Intervention ◽

Step Count ◽

Home Based ◽

At Home

Abstract Purpose Less than 10% of heart failure patients in the UK participate in cardiac rehabilitation programmes. The present pilot study evaluated feasibility, acceptability and physiological effects of a novel, personalised, home-based physical activity intervention in chronic heart failure. Methods Twenty patients (68 ± 7 years old, 20% females) with stable chronic heart failure due to reduced left ventricular ejection fraction (31 ± 8 %) participated in a single-group, pilot study assessing the feasibility and acceptability of a 12-week personalised home-based physical activity intervention aiming to increase daily number of steps by 2000 from baseline (Active-at-Home-HF). Patients completed cardiopulmonary exercise testing with non-invasive gas exchange and haemodynamic measurements and quality of life questionnaire pre- and post-intervention. Patients were supported weekly via telephone and average weekly step count data collected using pedometers. Results Forty-three patients were screened and 20 recruited into the study. Seventeen patients (85%) completed the intervention, and 15 (75%) achieved the target step count. Average step count per day increased significantly from baseline to 3 weeks by 2546 (5108 ± 3064 to 7654 ± 3849, P = 0.03, n = 17) and was maintained until week 12 (9022 ± 3942). Following completion of the intervention, no adverse events were recorded and quality of life improved by 4 points (26 ± 18 vs. 22 ± 19). Peak exercise stroke volume increased by 19% (127 ± 34 vs. 151 ± 34 m/beat, P = 0.05), while cardiac index increased by 12% (6.8 ± 1.5 vs. 7.6 ± 2.0 L/min/m2, P = 0.19). Workload and oxygen consumption at anaerobic threshold also increased by 16% (49 ± 16 vs. 59 ± 14 watts, P = 0.01) and 10% (11.5 ± 2.9 vs. 12.8 ± 2.2 ml/kg/min, P = 0.39). Conclusion The Active-at-Home-HF intervention is feasible, acceptable and effective for increasing physical activity in CHF. It may lead to improvements in quality of life, exercise tolerance and haemodynamic function. Trial Registration www.clinicaltrials.gov NCT0367727. Retrospectively registered on 17 September 2018.

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Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

10.21203/rs.3.rs-153919/v1 ◽

2021 ◽

Author(s):

Johanna Sommer ◽

Christopher Chung ◽

Dagmar M. Haller ◽

Sophie Pautex

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Palliative Care ◽

Pilot Study ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Communication Skills ◽

Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

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Changes in self-reported physical activity and health-related quality of life following 3-month astaxanthin supplementation in patients with heart failure: results from a pilot study

Annals of Palliative Medicine ◽

10.21037/apm-20-1378 ◽

2020 ◽

Vol 9 (5) ◽

pp. 24-24

Author(s):

Sayaki Ishiwata ◽

Takao Kato ◽

Takatoshi Kasai ◽

Akihiro Sato ◽

Shoichiro Yatsu ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Heart Failure ◽

Pilot Study ◽

Health Related Quality ◽

Patients With Heart Failure ◽

Related Quality ◽

Health Related

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Protocolled practice nurse-led care for children with asthma in primary care: protocol for a cluster randomised trial

BMJ Open ◽

10.1136/bmjopen-2018-022922 ◽

2019 ◽

Vol 9 (9) ◽

pp. e022922

Author(s):

Sara Bousema ◽

Annemieke J Verwoerd ◽

Lucas M Goossens ◽

Arthur M Bohnen ◽

Patrick J E Bindels ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

General Practitioner ◽

Asthma Control ◽

Practice Nurse ◽

Asthma Care ◽

Cluster Randomised ◽

Children With Asthma

IntroductionIn children with asthma, daily symptoms and exacerbations have a significant impact on the quality of life of both children and parents. More effective use of asthma medication and, consequently, better asthma control is advocated, since both overtreatment and undertreatment are reported in primary care. Trials in adults suggest that asthma control is better when patients receive a regular medical review. Therefore, protocolled care by the general practitioner may also lead to better asthma control in children. However, such protocolled care by the general practitioner may be time consuming and less feasible. Therefore, this study aims to determine whether protocolled practice nurse-led asthma care for children in primary care provides more effective asthma control than usual care.Methods and analysisThe study will be a cluster-randomised open-label trial with an 18-month follow-up. Practice nurses will be the units of randomisation and children with asthma the units of analysis. It is planned to include 180 children aged 6–12 years. Primary outcome will be average asthma control during the 18-month follow-up measured by the Childhood Asthma Control Test (C-ACT). Secondary outcomes include C-ACT scores at t=3, t=6, t=12 and t=18 months; the frequency and severity of exacerbations; cost-effectiveness; quality of life; satisfaction with delivered care; forced expiratory volume in 1 s and forced expiratory flow at 75% and the association of high symptoms scores at baseline and baseline characteristics. Besides, we will conduct identical measurements in a non-randomised sample of children.Ethics and disseminationThis will be the first trial to evaluate the effectiveness of protocolled practice nurse-led care for children with asthma in primary care. The results may lead to improvements in asthma care for children and can be directly implemented in revisions of asthma guidelines.The study protocol was approved by the Medical Research Ethics Committee of the Erasmus Medical Centre in Rotterdam.Trial registrationNTR6847.

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