scholarly journals Comorbid patient with arterial hypertension: difficulties in diagnosis and treatment

2022 ◽  
pp. 7-15
Author(s):  
E. I. Polozova ◽  
V. V. Skvortsov ◽  
A. A. Seskina ◽  
A. A. Mironov ◽  
A. R. Starova ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Chronic Diseases ◽  
Medical Knowledge ◽  
Daily Basis ◽  
Therapeutic Practice ◽  
General Pathology ◽  
Demographic Aging ◽  
Single Kidney

The problem of comorbidity becomes especially relevant in the conditions of demographic aging of the population. In recent years the number of studies devoted to diagnostic and treatment features of comorbidities, especially in elderly and senile patients, has increased. In spite of this fact, until now there are no clear recommendations for the management of comorbidities in the therapeutic practice.The article is devoted to the presentation and discussion of a clinical case of a comorbid patient with arterial hypertension. The stages of the performed diagnostic search with verification of the clinical diagnosis and the tactics of the prescribed pharmacotherapy are presented. On the basis of the presented data it is shown that exacerbation of one of the chronic diseases of the patient’s general comorbid background may significantly increase the severity of the general pathology and in its turn will determine the prognosis and influence the treatment tactics. The complexity of this case is that the patient has chronic single kidney disease in the stage of chronic renal failure. In analysing this case, it is also important to note the difficulties in the choice of drug therapy, as this situation poses significant limitations in the use of many drugs. This is a challenge that every clinician faces on a daily basis, regardless of clinical experience and medical knowledge. Only a multilevel approach will enable comprehensive medical and social care to be organised for patients with co-morbidities with chronic diseases, provide follow-up not only during exacerbations but also during remissions, contribute to the prevention of exacerbations and complications, which will consequently improve prognosis and quality of life.

scholarly journals The Distance Monitoring of Blood Pressure as a Tool for Improving of the Quality of Follow-Up Observation of Patients with Arterial Hypertension

2021 ◽  
Vol 11 (4) ◽  
pp. 255-263
Author(s):  
I. A. Starodubtseva ◽  
Yu. A. Sharapova
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Cardiovascular Complications ◽  
Pressure Monitoring ◽  
Blood Pressure Targets ◽  
Distance Counseling ◽  
The Right

This article focuses on the distant blood pressure monitoring for patients with arterial hypertension. As numerous studies show, even slightly elevated blood pressure significantly raises the risk of cardiovascular complications. And, vice versa, a 5 mmHg decrease in blood pressure reduces the lethality risk. Therefore, it is not enough to prescribe the right medication but also it is of paramount importance to monitor patients’ compliance with the treatment. Clinical observation of patients with arterial hypertension is an effective tool for the prevention of cardiovascular complications. However, to date, the coverage of follow-up and the achievement of blood pressure targets in patients with arterial hypertension is one of the most problematic aspects. Distance monitoring of blood pressure opens more opportunities for the doctor’s involvement, timely assessment and adjustment of the medication. The results of domestic and foreign research show high efficacy of the distance blood pressure monitoring. Positive results regarding the achievement of target blood pressure after 3 months are shown when using the technology of blood pressure monitoring and distance counseling of patients with arterial hypertension. In particular, the article considers the technology of mobile health care (mHealth), which is a more flexible platform for a patient’s continuous self-care.

scholarly journals Renal denervation with a resistant arterial hypertension: the results of a five-year follow-up

2018 ◽  
Vol 90 (9) ◽  
pp. 88-91 ◽  
Author(s):  
P V Glybochko ◽  
A A Svetankova ◽  
A V Rodionov ◽  
A S Maltseva ◽  
V A Sulimov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Arterial Hypertension ◽  
Kidney Function ◽  
Renal Denervation ◽  
Quality Of Life Indicators ◽  
Before And After ◽  
Resistant Arterial Hypertension

Aim. To evaluate the 5-year results of renal denervation (RDN) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 14 patients to whom, during the 2011-2013 period RDN has been completed. Before and after the intervention, office blood pressure, quality of life indicators according to the EQ-5D questionnaire, mass index bodies, indicators of kidney function were duly assessed. Results. Five years after RDN, office BP decreased from 165/110 to 139/95 mm Hg. Art. (p

scholarly journals Users’ Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Jacqueline Floch ◽  
Thomas Vilarinho ◽  
Annabel Zettl ◽  
Gema Ibanez-Sanchez ◽  
Joaquim Calvo-Lerma ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cystic Fibrosis ◽  
Mixed Methods ◽  
Chronic Diseases ◽  
Self Efficacy ◽  
The Self ◽  
Self Management ◽  
Management Approach

BACKGROUND Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. OBJECTIVE This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. METHODS A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. RESULTS Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. CONCLUSIONS Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF.

scholarly journals AB1177 METHODOLOGICAL ASPECTS OF DESIGN, ANALYSES AND REPORTING OF STUDIES WITH WORK PARTICIPATION AS OUTCOME DOMAIN IN PATIENTS WITH INFLAMMATORY ARTHRITIS: RESULTS OF TWO SYSTEMATIC LITERATURE REVIEWS INFORMING EULAR POINTS TO CONSIDER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1879.1-1880
Author(s):  
A. Alunno ◽  
M. L. Marques ◽  
A. Boonen ◽  
L. Falzon ◽  
S. Ramiro ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Contextual Factors ◽  
Methodological Issues ◽  
Work Related ◽  
Methodological Choices ◽  
Work Outcome ◽  
Outcome Domain ◽  
Methodological Aspects

Background:Inflammatory arthritis (IA) has substantial impact on work participation (WP). However, methodological issues hamper interpretation, comparison and meta-analyses of studies with WP as outcome domain. Sources of heterogeneity and methodological choices should be assessed in order to improve the quality of future studies.Objectives:To summarize methodological choices in studies with WP as outcome domain in IA and other chronic diseases.Methods:A EULAR task force on ‘points to consider (PtC) when designing, analysing and reporting studies with WP as outcome domain among patients with IA’ outlined the scope of the systematic literature review (SLR) and identified 6 areas of potential concern (Table 1). Two searches were conducted (Figure 1): Search 1 (S1): original studies in IA (RCTs and longitudinal prospective observational studies); S2: systematic reviews in other chronic diseases. Two reviewers independently identified eligible studies and extracted data for the pre-defined methodological areas.Table 1.Methodological issues across the 6 pre-defined areas (search 1, n=62)AreaMethodological issues*1. Study design- 16/62 (26%) and 8/62 (13%) studies aligned the target population and sample size with the study’s work outcome.- 9/39 (24%) of the interventional studies aimed to assess changes of work status (employment/disability) over a very short follow-up time (≤6 months).2. Work outcome domains- 7/33 (21%) of studiesdefined work status.- 30/30 (100%), 38/38 (100%) and 7/7 (100%)defined absenteeism, presenteeism and unpaid work, respectively.3. Work outcome measurement instruments- 22/62 (35%) studies usednon-validated instruments(e.g. self-reported days of sick leave/impact of disease on productivity, n=16/62, 26%).4. Contextual factors- 54/62 (87%) studies neglected work-related contextual factors.5. Data analysesOf the studies measuring absenteeism and/or presenteeism:- 10/38 (26%) accounted forskewnessof the work outcome.- 30/38 (79%) tookinterdependencebetween outcomes as part of work productivity and activity impairment questionnaire into account.6. Reporting- 62/62 (100%) studies reported the size and characteristics of the (sub)groups in which the analyses were performed.- 1/62 (2%) reported loss to follow-up and work-related reasons for drop-out.- 42/62 (68%) studies presentedaggregatedresults; 11/62 (18%) presented results aspercentages according to meaningful thresholds; 9/62 (14%): both forms.- 21/24 (88%) studies reportingproductivity costs,provided data on natural volumes (days/hours) used to calculate costs.*The number of studies in denominators vary by methodological issue.Results:We included 62 original studies in IA (23 RCTs, 16 interventional and 23 non-interventional observational studies) and 28 SLRs in other chronic diseases. The methodological aspects most often neglected in original studies (Table 1) were: the choice of the study design in relation to the work-related study objective; definitions of the WP outcome domains considered; accounting for skewness of the work outcome; consideration of work-related contextual factors; reporting attrition and its reasons and reporting both aggregated results as well as proportions of individuals based on predefined meaningful thresholds. SLRs on other chronic diseases confirmed high heterogeneity and methodological flaws in all the 6 key methodological areas without identifying new problematic areas.Conclusion:High methodological heterogeneity was observed in studies with WP. Consensus around the key methodological aspects is needed to homogenise and improve the quality of future studies. This review informs the EULAR PtC for the conduction and reporting of studies with WP as an outcome domain in IA.Disclosure of Interests:Alessia Alunno: None declared, Mary Lucy Marques: None declared, Annelies Boonen Grant/research support from: AbbVie, Consultant of: Galapagos, Lilly (all paid to the department), L. Falzon: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Polina Putrik: None declared

scholarly journals Users’ Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study

10.2196/15896 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e15896 ◽  
Author(s):  
Jacqueline Floch ◽  
Thomas Vilarinho ◽  
Annabel Zettl ◽  
Gema Ibanez-Sanchez ◽  
Joaquim Calvo-Lerma ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cystic Fibrosis ◽  
Mixed Methods ◽  
Chronic Diseases ◽  
Self Efficacy ◽  
The Self ◽  
Self Management ◽  
Management Approach

Background Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF.

Pulmonary Arterial Hypertension Complicating Congenital Heart Disease: Advances in Therapy

2017 ◽  
Vol 38 (05) ◽  
pp. 636-650 ◽  
Author(s):  
Margarita Brida ◽  
Laura Price ◽  
Colm McCabe ◽  
Rafael Alonso-Gonzalez ◽  
Stephen Wort ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Term Survival ◽  
Pulmonary Arterial

AbstractCongenital heart disease (CHD) is the most common inborn defect, affecting approximately 1% of all newborns worldwide. Advances in its diagnosis and treatment have led to dramatic improvements in patients' quality of life and long-term survival. Nevertheless, despite these innovations many patients require life-long follow-up and are at risk of numerous complications, namely, residual or progressive hemodynamic lesions, arrhythmia, sudden cardiac death, and the development of heart failure and pulmonary arterial hypertension (PAH), despite timely surgical intervention. Ill advisedly, some patients are also lost to follow-up, assuming that their early life surgical or catheter-based intervention was curative, hence missing out on invaluable lifetime screening and timely interventions that may be necessary. Additionally, there are many patients with undiagnosed or unoperated CHD in the developing world presenting later in life with irreversible complications. Even in this modern era of diagnosis and screening, PAH-CHD remains a burden in patients with CHD, with approximations of up to 10% in this heterogeneous group and is associated with an adverse impact on quality of life and survival.

scholarly journals Dermoscopic findings in female androgenetic alopecia

2012 ◽  
Vol 87 (5) ◽  
pp. 691-694 ◽  
Author(s):  
Lya Duarte Ramos ◽  
Maria Cândida Nahás Santili ◽  
Fabiane Castilho Bezerra ◽  
Maria de Fátima Maklouf Amorim Ruiz ◽  
Valeria Petri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Early Diagnosis ◽  
Therapeutic Response ◽  
Digital Camera ◽  
Self Esteem ◽  
Daily Basis ◽  
Androgenetic Alopecia ◽  
Excellent Tool

BACKGROUND: Androgenetic alopecia is the most common form of hair loss. It is a clinical entity of relevant interest and presents a significant psychosocial impact as it undermines self-esteem and quality of life in female patients due to the importance of the hair for people's facial balance. OBJECTIVE: The purpose of the present study is to evaluate dermoscopic signs in women clinically diagnosed with androgenetic alopecia. METHOD: Observational study with 34 women between 17 and 68 years old who were diagnosed with androgenetic alopecia. All of them underwent photographic sessions with a 10x magnification dermoscope and a digital camera zoom set to 20x magnification and 40x magnification on the scalp frontal midline. RESULTS: All patients showed miniaturization. A peripilar brown halo was found in 22 patients, honeycomb-like scalp pigmentation was found in 14 and yellow dots in only 1 patient. Recent studies show dermoscopy as the new tool for diagnosis assistance and treatment follow up in scalp disorders. Our study used an ordinary dermoscope and we evaluated several findings reported in the literature with significant clarity and easiness. CONCLUSION: The dermoscope, which is used by dermatologists on a daily basis, is an excellent tool to assist in early diagnosis and assessment of therapeutic response in androgenetic alopecia.

scholarly journals Impact of SARS-CoV-2-Pandemic on Mental Disorders and Quality of Life in Patients With Pulmonary Arterial Hypertension

2021 ◽  
Vol 12 ◽  
Author(s):  
Da Hee Park ◽  
Jan Fuge ◽  
Tanja Meltendorf ◽  
Kai G. Kahl ◽  
Manuel J. Richter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Medical Care ◽  
Anxiety And Depression ◽  
Pulmonary Arterial ◽  
Access To Medical Care ◽  
The Impact

Background/Objective: Covid-19 pandemic may affect mental health and quality of life (QoL) in patients with pulmonary arterial hypertension (PAH). We assessed changes in anxiety and depression, quality of life (QoL) and self-described impact of Covid-19 in patients with PAH during the Covid-19 pandemic.Methods: This study included 152 patients with PAH from two German referral centers. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) at two different timepoints before and during the Covid-19 pandemic with a median of 232 days between baseline and follow-up. QoL was assessed using EQ-5D and emPHasis-10. Perceived impact of Covid-19 and related regulations and measures were assessed using a set of specific questions and statements.Results: More than two thirds of patients had an unsuspicious HADS-A and HADS-D. Median scores did not differ from baseline for both HADS-A and HADS-D (p = 0.202; p = 0.621). Overall, no significant changes in HADS-A or HADS-D categories from baseline to follow up were observed (p = 0.07; p = 0.13). QoL did not change between baseline and follow-up. The Covid-19 pandemic had little impact on access to medical care and established PAH therapy. Patients were in agreement with governmental measures and regulations and felt sufficiently safe.Conclusion: First waves of Covid-19 pandemic had little impact on anxiety, depression and QoL in patient with PAH. Established PAH therapy and access to medical care were not affected. Further studies on the impact of prolonged duration of the ongoing Covid-19 pandemic are needed.

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