scholarly journals The effect of problem-based learning after coronary heart disease – A randomised study in primary health care (COR-PRIM)

2020 ◽  
Author(s):  
Anita Kärner Köhler ◽  
Tiny Jaarsma ◽  
Pia Tingström ◽  
Staffan Nilsson
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Patient Information ◽  
Patient Empowerment ◽  
Self Care ◽  
Problem Based Learning ◽  
Hdl Cholesterol ◽  
One Year ◽  
Experimental Group

Abstract Background Cardiac rehabilitation including patient education is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. The aim of the study was to demonstrate the better effectiveness of patient problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. The hypothesis tested was that one year of problem-based learning improves patients’ empowerment- and self-efficacy, to change self-care compared to one year of standardised home-sent patient information after CHD. Methods We randomly assigned 157 patients (78% male; age 68±8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) to problem-based learning (experimental group; n = 79) or home-sent patient information group (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over one year. Controls received home- sent patient information on 11 occasions during the study year. Results At the one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [-0.17 (SD 1.5) vs. 0.50 (SD 1.6), P=0.033 ], body weight [-0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P=0.026 ] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P=0.038 ] favouring the experimental group compared to controls. Conclusions The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information intervention. Trial registration : NCT01462799 (February 2020)

scholarly journals The effect of problem-based learning after coronary heart disease – A randomised study in primary health care (COR-PRIM)

2019 ◽  
Author(s):  
Anita Kärner Köhler ◽  
Tiny Jaarsma ◽  
Pia Tingström ◽  
Staffan Nilsson
Keyword(s):  
Health Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Primary Health Care ◽  
Patient Information ◽  
Patient Empowerment ◽  
Problem Based Learning ◽  
Primary Health ◽  
One Year ◽  
Experimental Group

Abstract Background The hypothesis tested was that one year of problem-based learning (PBL) improves patients’ self-efficacy, and empowerment to change self-care significantly compared to one year of standardised home-sent patient information after an event of coronary heart disease (CHD). Methods We randomly assigned 157 patients (78% male; age 68±8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) to either PBL (experimental group; n = 79) or home-sent patient information group (controls; n = 78). The PBL intervention consisted of a patient education in primary health care by trained district nurses who tutored groups of 6-9 patients on 13 occasions over one year. Controls received home- sent patient information on 11 occasions during the study year. Results At the one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [-0.17 (SD 1.5) vs. 0.50 (SD 1.6), P=0.033 ], body weight [-0.83 (SD 4.45 vs. 1.14 kg (SD 4.85), P=0.026 ] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P=0.038 ] for the experimental group compared to controls. Conclusions The PBL and the home-sent patient information interventions had similar results regarding patient empowerment. However, PBL exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that the PBL intervention positively affected risk factors compared to the home-sent patient information intervention. Trial registration : NCT01462799 (August 2019, date last accessed) Keywords: Problem-based learning, Coronary Heart Disease, Primary Health Care, Patient empowerment, Risk factors, Self-care

MULTI-AGENT INTELLIGENT SYSTEM FOR PREDICTION OF RISK OF CARDIOVASCULAR COMPLICATIONS WITH SYNERGY CHANNELS

2020 ◽  
pp. 177-188
Author(s):  
Ольга Владимировна Шаталова ◽  
Дмитрий Андреевич Медников ◽  
Зейнаб Усама Протасова
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Intelligent Systems ◽  
Intelligent System ◽  
Control Group ◽  
Systems Research ◽  
Multi Agent ◽  
Experimental Group

Цель исследования заключается в повышении качества прогнозирования ишемической болезни сердца путем учета синергетического эффекта наличия сопутствующих заболеваний и факторов профессиональной среды посредством многоагентных интеллектуальных систем. Методы исследования. Для прогнозирования ишемической болезни сердца предложена базовая структура многоагентной интеллектуальной системы, содержащая «сильные» и «слабые» классификаторы. При этом «слабые» классификаторы разделены на четыре группы, первая из которых осуществляет анализ данных, полученных на основе традиционных факторов риска ишемической болезни сердца, вторая - на основе анализа электрокардиологических исследований, третья группа «слабых» классификаторов предназначена для диагностики сопутствующих заболеваний и синдромов по предикторам, используемых первыми двумя группами агентов, а четвертая - анализирует факторы риска окружающей среды. Мультиагентная система позволяет управлять процессом принятия решений посредством сочетания экспертных оценок, статистических данных и текущей информации. Результаты. Проведены экспериментальные исследования различных модификаций предложенной модели классификатора, заключающихся в последовательном исключении из агрегатора решений «слабых» классификаторов на различных иерархических уровнях. В ходе экспериментального оценивания и в результате математического моделирования было показано, что при использовании всех информативных признаков уверенность в правильном прогнозе по риску ишемической болезни сердца превышает величину 0,8. Показатели качества прогнозирования выше, чем у известной системы прогнозирования ишемической болезни сердца - превышает SCORE, в среднем, на 14%. Выводы. Анализ показателей качества классификации в экспериментальной группе обследуемых с различным показателем ишемического риска и в контрольной группе, составленной из машинистов электролокомотивов, для которых релевантными показателями ишемических рисков являются вибрационная болезнь и пребывание в электромагнитных полях, показал, что учет влияния этих факторов риска в контрольной группе повышает диагностическую эффективность на семь процентов по сравнению с экспериментальной группой, выступающей как фоновая The aim of the study is to improve the quality of predicting coronary heart disease by taking into account the synergistic effect of the presence of concomitant diseases and occupational factors through multi-agent intelligent systems. Research methods. To predict coronary heart disease, a basic structure of a multi-agent intelligent system is proposed, which contains “strong” and “weak” classifiers. At the same time, the "weak" classifiers are divided into four groups, the first of which analyzes data obtained on the basis of traditional risk factors for coronary heart disease, the second - based on the analysis of electrocardiological studies, the third group of "weak" classifiers is intended for the diagnosis of concomitant diseases and syndromes based on predictors used by the first two groups of agents, and the fourth analyzes environmental risk factors. The mobile system allows you to manage the decision-making process through a combination of expert assessments, statistical data and current information. Results. Experimental studies of various modifications of the proposed model of the classifier, consisting in the sequential exclusion from the aggregator of decisions of "weak" classifiers at various hierarchical levels, have been carried out. In the course of experimental evaluation and as a result of mathematical modeling, it was shown that when using all informative signs, the confidence in the correct forecast for the risk of coronary heart disease exceeds 0.8. The indicators of the quality of prediction are higher than those of the known predictive system for coronary heart disease - they exceed SCORE, on average, by 14%. Conclusions. Analysis of the classification quality indicators in the experimental group of subjects with different ischemic risk indicators and in the control group made up of electric locomotive drivers, for whom vibration sickness and exposure to electromagnetic fields are relevant indicators of ischemic risks, showed that taking into account the influence of these risk factors in the control group increases diagnostic efficiency by seven percent compared with the experimental group serving as background

Abstract 19: Dietary Lipophilic Load and Dietary Lipophilic Index with Risk of Coronary Heart Disease in Middle-Aged Women: Beyond Conventional Fat Classifications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Eric L Ding ◽  
Katerina M De Vito ◽  
Hongyu Wu ◽  
Qi Sun ◽  
An Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Dietary Fat ◽  
Hdl Cholesterol ◽  
Health Study ◽  
Chd Risk ◽  
Increased Risk ◽  
Total Fat ◽  
Traditional Risk Factors

Introduction: Studies indicate dietary types of fats are associated with risk of coronary heart disease (CHD). Traditional broad classifications may incompletely capture the diversity of fatty acids on CHD. The novel lipid index Dietary Lipophilic Load (DLL) reflects a unique combination of fatty acid fluidity, intermolecular attraction, plus relative fat quantity, while Dietary Lipophilic Index (DLI) is a measure of average fat fluidity, regardless of fat quantity. Thus, we evaluated the association, DLL and DLI, with risk of incident CHD. METHODS: Participants included 30,932 women in the Women’s Health Study (WHS), who were free of major chronic diseases at baseline. DLL was calculated by weighted summation of the multiplicative product of each fatty acid’s intakes (g/day) and its melting points (Celcius); DLI was calculated by dividing DLL by total fat intake (g/day). Hazard ratios (HRs) were adjusted for established risk factors, with updated dietary data, and potential mediators. We also investigated hypothesized interactions with C-Reactive Protein (CRP). RESULTS: There were 1137 cases of incident CHD in 525,828 person-years over 19 years follow-up. At baseline in over 27,000 women with blood samples, DLL and DLI were not correlated with serum cholesterol, triglyceride, HbA1c, ICAM-1, or CRP biomarkers (r<0.02 for all). In overall multivariate analysis, DLL was associated with higher risk of CHD (extreme quintile HR=1.40, 95%CI: 1.11-1.76, P trend=0.0002), while DLI was not (HR=0.83, 95%CI: 0.67-1.03, P trend=0.75). DLL results were independent beyond adjustment for dietary trans, saturated, monounsaturated, and polyunsaturated fats, nor their aggregate adjustment or the P:S ratio. DLL effects persisted even adjusting for CRP (HR=1.29, P-trend=1 mg/dL for DLL (extreme quintile HR=1.38, 1.02-1.88), than among individuals with low CRP <1 mg/dl for DLL (HR=1.08, 0.68-1.72), with P-interaction<0.0001. Furthermore, CRP also modified DLI, where effects again diverged among higher CRP (HR=0.98, 0.73-1.31) versus low CRP (HR=0.45, 0.27-0.74), with P-interaction<0.0001. Moreover, adjustment of triglycerides, HbA1c, ICAM-1, LDL or HDL cholesterol also did not materially affect overall results. CONCLUSION: Results indicate that DLL is associated with increased risk of incident CHD, independent of traditional risk factors, conventional dietary fat classifications, and major CHD biomarkers. Effects of DLL and DLI appear to be modified by levels of CRP. DLL appears to be an important novel dietary fat index that captures additional CHD risk information beyond biomarkers and traditional dietary fat categories. Further studies are warranted.

The correlation of apolipoprotein B, apolipoprotein B/apolipoprotein A-I ratio and lipoprotein(a) with myocardial infarction

Open Medicine ◽  
2008 ◽  
Vol 3 (4) ◽  
pp. 422-429
Author(s):  
Lucia Agoston-Coldea ◽  
Teodora Mocan ◽  
Marc Gatfossé ◽  
Dan Dumitrascu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Cardiovascular Risk Factors ◽  
Apolipoprotein B ◽  
Hdl Cholesterol ◽  
Lipoprotein A

AbstractRecent evidence shows that apolipoprotein (apo) B, apoB/apoA-I ratio and lipoprotein(a) are better indicators of coronary risk than the conventional lipid profile. The aim of this study was to evaluate the correlation of apoA-I and B, and lipoprotein(a) with myocardial infarction (MI). We performed a cross-sectional study including 208 patients (100 men and 108 women), with and without previous MI evaluated by coronary angiography. The severity of coronary heart disease was scored on the basis of the number and extent of lesions in the coronary arteries. Lipid levels were measured by the enzymatic method and apolipoprotein levels were measured by the immunoturbidimetric method. The MI group had higher plasmatic levels of lipoprotein(a) (0.37±0.28 vs. 0.29±0.23 g/L, p<0.05), apoB (1.13±0.40 vs. 0.84±0.28 g/L, p<0.05) and of the apoB/apoA-I ratio (0.77±0.37 vs. 0.68±0.20, p<0.05) compared to controls. The area under the receiver operating characteristic (ROC) curves (AUC) suggested a good reliability in the diagnose of coronary heart disease for the apoB/apoA-I ratio (0.756, p<0.05), apoB (0.664, p<0.05), lipoprotein(a) (0.652, p<0.05) and total cholesterol/HDL-cholesterol (0.688, p<0.05). Multivariate analysis performed with adjustments for cardiovascular risk factors, showed that the levels of lipoprotein(a), apoB and apoB/apoA-I ratio are significant independent cardiovascular risk factors. Our results indicate that there is an important relationship among high plasma apoB concentration, lipoprotein(a) concentration, the apoB/apoA-I ratio, and MI. We showed that the apoB/apoA-I ratio has a stronger correlation with MI than the total cholesterol/HDL cholesterol ratio. We therefore suggest using apoB/apoA-I ratio and lipoprotein(a) in clinical practice as a markers of MI risk.

scholarly journals Risk for coronary heart disease in people with severe mental illness

2006 ◽  
Vol 188 (3) ◽  
pp. 271-277 ◽  
Author(s):  
David P. J. Osborn ◽  
Irwin Nazareth ◽  
Michael B. King
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Mental Illness ◽  
Heart Disease ◽  
Severe Mental Illness ◽  
Hdl Cholesterol ◽  
Risk Scores ◽  
Systematic Research ◽  
Chd Risk ◽  
Chd Risk Factors

BackgroundDespite concern about the incidence of coronary heart disease (CHD) in people with severe mental illness (SMI), there is little systematic research on CHD risk factors in this population.AimsTo compare the main risk factors for CHD in people with and without SMI in primary care, to investigate the role of socio-economic variables, and to examine any association between antipsychotic medication and CHD risk.MethodCross-sectional screening.ResultsIn total, 75 of 182 general practice patients with SMI and 150 of 313 such patients without SMI attended the interview. SMI was associated with: raised 10-year CHD risk scores (OR= 1.8, 95% CI 1.0–3.1); high-density-lipoprotein (HDL)-cholesterol levels <l.0 mmol/l (OR=4.0, 95% CI 1.5–10.7); raised cholesterol/HDL-cholesterol ratios (OR=1.8, 95% CI 1.0–3.2); diabetes mellitus (OR=3.8, 95% CI 1.1–13.3) and smoking (OR=3.0, 95% CI 1.7–3.4). These associations varied significantly with age. Adjustment for unemployment did not fully explain the associations.ConclusionsExcess risk factors for CHD are not wholly accounted for by medication or socio-economic deprivation. There is an urgent need for CHD screening and for relevant interventions for smoking cessation and diabetes, as well as advice on diet and exercise, in patients with SMI.

scholarly journals Association of lipids with coronary heart disease in a saudi population

2011 ◽  
Vol 10 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Mohmed Elfatih Ashmaig ◽  
Khalifa Ashmeik ◽  
Atif Ahmed ◽  
Samia Sobki ◽  
Muheeb Abdulla
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Risk ◽  
Significant Risk ◽  
Hdl Cholesterol ◽  
Saudi Population ◽  
Blood Draw ◽  
Small Dense Ldl ◽  
Low Hdl

BACKGROUND: The Saudi population is known to have an unhealthy diet in addition to physical inactivity. OBJECTIVE: To investigate the lipid-mediated risk factors that might be associated with increased incidence of coronary heart diseasein the Saudi population as this was found in Western populations. MATERIALS AND METHODS: Two hundred and twenty subjects suspected of having coronary heart disease underwent coronary angiography and blood draw following a 12-hour fast. Total and HDL cholesterol, triglycerides, Lp(a) and lipoprotein lipase were measured by standard methods. Small, dense LDL was measured by the iodixanol method with an ultracentrifugation of only 2.5 hours. RESULTS: One hundred and forty subjects were found to be positive for coronary heart disease while 80 subjects were shown to be negative for this disease. Statistically significant risk factors for coronary heart disease in the Saudi population were hypertriglyceridemia (1.93±0.95 versus1.45±0.16 mmol/L;p<0.0001); low HDL cholesterol (1.09±0.55 vs 1.33±0.63 mmol/L, p=0.0001); high Lp(a) (46.8±45.58 versus 29.06±17.03 mg/dL;p=0.019); and the presence of small, dense LDL (1.0314±0.0028 versus 1.0300±0.0003 g/kg;p=0.0099). Total cholesterol (4.99±1.11 versus 4.75±1.11 mmol/L;p=0.099), LPL (35.56±26.6 versus 27.89±11.96 IU/L;p<0.059), and LDL cholesterol (3.06±1.12 versus 2.79±1.08 mmol/L;p=0.08) were not found to be statistically significant coronary heart disease risk factors. CONCLUSIONS: This study indicates that high TG, low HDL, high Lp(a) and the presence of small, dense LDL may contribute to the incidence of coronary heart disease and that TC was not significantly associated with incidence of coronary heart disease in the Saudi population.

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