Design of an early remote coaching program to bridge the gap from hospital discharge to the start of cardiac rehabilitation. (Preprint)

2021 ◽  
Author(s):  
Paul Keessen ◽  
Ingrid CD van Duijvenbode ◽  
Corine HM Latour ◽  
Roderik A Kraaijenhagen ◽  
Veronica R Janssen ◽  
...  
Keyword(s):  
Side Effects ◽  
Cardiac Rehabilitation ◽  
Hospital Discharge ◽  
Treatment Plan ◽  
Health Behavior Change ◽  
Support Needs ◽  
Structured Interviews ◽  
Literature Study ◽  
Daily Physical Activities ◽  
Tailored Information

BACKGROUND Remote coaching might potentially be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR). OBJECTIVE To explore and summarize information- and support needs of patients with CAD, and to develop an early remote coaching program providing tailored information and support. METHODS We used the intervention mapping (IM) approach to develop a remote coaching program. Three consecutive steps were completed in this study: (1) identification of information- and support needs in patients with CAD, using an exploratory literature study and semi-structured interviews; (2) definition of program objectives; (3) selection of theory-based methods and practical intervention strategies. RESULTS Our exploratory literature study (n=42) and semi-structured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about: CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: 1. Patients gain knowledge on how CAD and revascularization affects their bodies and health. 2. Patients gain knowledge about medication and side effects and adhere to their treatment plan. 3. Patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active. 4. Patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as theoretical framework, and behavioral counseling and video modelling as practical strategies for the program. CONCLUSIONS In this study we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

scholarly journals Bridging the gap from hospital discharge to cardiac rehabilitation using the intervention mapping approach (BRIDGE2CARE)

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Keessen ◽  
ICD Van Duijvenbode ◽  
CHM Latour ◽  
RA Kraaijenhagen ◽  
V Janssen ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Side Effects ◽  
Cardiac Rehabilitation ◽  
Hospital Discharge ◽  
Intervention Mapping ◽  
Physical Activities ◽  
Public Institution ◽  
Support Needs ◽  
Structured Interviews ◽  
Daily Physical Activities

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dutch Research Council INTRODUCTION Cardiac rehabilitation (CR) is the cornerstone of secondary prevention. After hospital discharge, patients have to wait for participation in CR while often feeling overwhelmed by their cardiac event and in need of tailored information and support.   PURPOSE The objective of this study was to develop a remote (digital) intervention to bridge the gap from hospital discharge to CR. METHODS We developed an intervention by completing the first three steps of the intervention mapping protocol. Step 1: identification of information- and support needs from the literature and semi-structured interviews. Step 2: Describing performance objectives for the intervention and selecting determinants. Step 3: Generation of program themes and theory based change methods. RESULTS (Step 1) The following Information- and support needs were identified from the literature (n = 33) and semi structured interviews (n = 22): information about pathology and intervention, medication and side effects, daily physical activities, psychological distress, body signals and social support. Advanced communication and pedagogical skills of the health care provider and the ability to build trust were described as important prerequisites for the intervention. (Step 2) The following performance objectives were formulated: (1) Patients gain knowledge on how their cardiac illness and procedure affects their bodies and health, (2) Patients gain knowledge about medication and side effects, (3) Patients know which daily physical activities they can and can’t do after hospital discharge and are physically active, (4) Patients and informal caregivers can deal with psychological distress and know how to discriminate between harmful and harmless body signals. Objectives were described per determinant (knowledge, skill, attitude, social influence, self-efficacy and outcome expectation). (Step 3) A comprehensive remote intervention was developed using theory based coaching strategies, a digital patient platform and information videoclips. CONCLUSION This study describes the information and support needs of patients after cardiac hospitalization and offers a remote intervention that bridges the gap form hospital discharge to CR. Abstract Figure. BRIDGE2CARE

Cancer treatment decisions for people living with dementia: experiences of family carers

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711545
Author(s):  
Catherine Hynes ◽  
Caroline Mitchell ◽  
Lynda Wyld
Keyword(s):  
Cancer Treatment ◽  
Healthcare Professionals ◽  
Cancer Recurrence ◽  
Treatment Decisions ◽  
Support Needs ◽  
Family Carers ◽  
Structured Interviews ◽  
Power Of Attorney ◽  
Cancer Data ◽  
People With Dementia

BackgroundDementia and cancer are both diseases associated with older age. The National Cancer Data Audit in England found that 4.4% of people diagnosed with cancer also had cognitive impairment. Decisions about cancer treatment can be very complex when someone already has dementia. Often someone’s closest relative may be asked to make decisions on their behalf. Little is known about the psychosocial impact that this has on carers, or what their support needs are during this time.AimTo explore the experiences of family carers who have been involved in making cancer treatment decisions on behalf of a relative with dementia, in particular identifying challenges and support needs.MethodThe authors are conducting semi-structured interviews with carers of people with dementia who have been involved in making decisions about cancer treatment on their behalf. Data is being thematically analysed using an inductive approach. Two researchers will independently verify themes.ResultsThe authors expect to have completed 14–18 interviews and will report their preliminary findings. Family carers experience many difficulties in the context of cancer and dementia, including lack of support when coping with the aftereffects of cancer treatment, lack of awareness among healthcare professionals regarding the authority granted by a lasting power of attorney and the anxiety created by feeling responsible for identifying cancer recurrence.ConclusionThis study will highlight that supporting someone with dementia through cancer treatment, and having to make decisions about it on their behalf, creates unique challenges for carers. Currently there is a significant lack of support for those facing this distressing experience.

scholarly journals Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Carlos Ramírez-Paesano ◽  
Albert Juanola Galceran ◽  
Claudia Rodiera Clarens ◽  
Vicenҫ Gilete García ◽  
Bartolomé Oliver Abadal ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Hospital Discharge ◽  
Case Series ◽  
Ehlers Danlos Syndrome ◽  
Painful Condition ◽  
Discharge Data ◽  
Gastrointestinal Complications ◽  
Case Series Study ◽  
Series Study

Abstract Background Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic. Methods A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values < 0.05. Results Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54–5.37) vs. OP 6.39 (6.07–6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

Patient perceptions of experience with cardiac rehabilitation after isolated heart valve surgery

2017 ◽  
Vol 17 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Tina B Hansen ◽  
Selina K Berg ◽  
Kirstine L Sibilitz ◽  
Ann D Zwisler ◽  
Tone M Norekvål ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Heart Valve ◽  
Isolated Heart ◽  
Personal Responsibility ◽  
Training Programme ◽  
Valve Surgery ◽  
Rehabilitation Programme ◽  
Heart Valve Surgery ◽  
Structured Interviews ◽  
Cardiac Rehabilitation Programme

Background: Little evidence exists on whether cardiac rehabilitation is effective for patients after heart valve surgery. Yet, accepted recommendations for patients with ischaemic heart disease continue to support it. To date, no studies have determined what heart valve surgery patients prefer in a cardiac rehabilitation programme, and none have analysed their experiences with it. Aims: The purpose of this qualitative analysis was to gain insight into patients’ experiences in cardiac rehabilitation, the CopenHeartVR trial. This trial specifically assesses patients undergoing isolated heart valve surgery. Methods: Semi-structured interviews were conducted with nine patients recruited from the intervention arm of the trial. The intervention consisted of a physical training programme and a psycho-educational intervention. Participants were interviewed three times: 2–3 weeks, 3–4 months and 8–9 months after surgery between April 2013 and October 2014. Data were analysed using qualitative thematic analysis. Results: Participants had diverse needs and preferences. Two overall themes emerged: cardiac rehabilitation played an important role in (i) reducing insecurity and (ii) helping participants to take active personal responsibility for their health. Despite these benefits, participants experienced existential and psychological challenges and musculoskeletal problems. Participants also sought additional advice from healthcare professionals both inside and outside the healthcare system. Conclusions: Even though the cardiac rehabilitation programme reduced insecurity and helped participants take active personal responsibility for their health, they experienced existential, psychological and physical challenges during recovery. The cardiac rehabilitation programme had several limitations, having implications for designing future programmes.

Effect of a Computerized Referral at Hospital Discharge on Cardiac Rehabilitation Participation Rates

2009 ◽  
Vol 29 (6) ◽  
pp. 365-369 ◽  
Author(s):  
Enkhtuyaa Mueller ◽  
Patrick D. Savage ◽  
David J. Schneider ◽  
Laura L. Howland ◽  
Philip A. Ades
Keyword(s):  
Cardiac Rehabilitation ◽  
Hospital Discharge ◽  
Participation Rates

scholarly journals Meanings of Family Support in the Treatment of Drug Dependence

2018 ◽  
Vol 28 (0) ◽  
Author(s):  
Laís Ramos Sanches ◽  
Tassiana Gonçalves Constantino dos Santos ◽  
Thaísa Borges Gomes ◽  
Marcelo Dalla Vecchia
Keyword(s):  
Social Support ◽  
Family Support ◽  
Family Involvement ◽  
Drug Dependence ◽  
Support Needs ◽  
Family Participation ◽  
Structured Interviews ◽  
Problematic Use ◽  
The Family ◽  
Alcohol And Other Drugs

Abstract The family is a key element of social support in the treatment of people who experience problems resulting from the use of alcohol and other drugs. This article aimed to understand the meanings of individuals under treatment due to the problematic use of alcohol and other drugs in relation to family participation. Six semi-structured interviews were carried out with people who adhered or not to the treatment proposed by an institution similar to a therapeutic community, analyzed later by analysis of thematic content. It was possible to observe (a) the low family involvement during the treatment, (b) the stigmatization and the individualization of the problematic use of alcohol and other drugs, and (c) the care focused on the figure of women. Guidance, listening and support needs for family members need to be properly examined during treatment to promote adherence.

scholarly journals ‘I was in control of it from the start’: A qualitative study of men’s experiences of positive adjustment following a heart attack

2016 ◽  
Vol 22 (10) ◽  
pp. 1345-1354
Author(s):  
Fran Smith ◽  
Elizabeth Banwell ◽  
Roby Rakhit
Keyword(s):  
Qualitative Study ◽  
Cardiac Rehabilitation ◽  
Coping Strategies ◽  
Heart Attack ◽  
Adaptive Coping ◽  
Structured Interviews ◽  
Cardiac Rehabilitation Programme ◽  
Positive Adjustment ◽  
Interpersonal Factors ◽  
Controllable Factors

A qualitative design was used to explore the experience of positive adjustment following a heart attack. Ten men attending a cardiac rehabilitation programme completed in-depth semi-structured interviews. An overarching theme: ‘I was in control of it from the start’ emerged with six subthemes, relating to intrapersonal and interpersonal factors and processes. The subthemes reflected the importance of identifying controllable versus non-controllable factors and employing adaptive coping strategies.

scholarly journals Home-Based Cardiac Rehabilitation During COVID-19: A Qualitative Study

2021 ◽  
Author(s):  
Smitha Ganeshan ◽  
Crystal Tse ◽  
Alexis Beatty
Keyword(s):  
Cardiac Rehabilitation ◽  
Organizational Factors ◽  
Structured Interviews ◽  
Ongoing Research ◽  
Staff Members ◽  
Use Of Technology ◽  
Home Based ◽  
Mobile Phone Applications ◽  
Delivery Models

Abstract Background: Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity, and hospitalizations. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research.Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

scholarly journals ANAL FISTULA TREATED BY HOMEOPATHY IN A FRENCH BULLDOG - CASE REPORT

2021 ◽  
pp. 143-145
Author(s):  
Ana Catarina Viana Valle ◽  
Aloísio Cunha de Carvalho
Keyword(s):  
Side Effects ◽  
Anal Fistula ◽  
Treatment Time ◽  
Treatment Plan ◽  
Perianal Fistula ◽  
Small Animal ◽  
Natural Tendency ◽  
Clinical Changes ◽  
French Bulldog ◽  
German Physician

Introdution: Anal fistula/perianal is a disease that affects the anal tissue and adjacent skin, associated with severe skin infections. The occurrence of this disease is higher than it appears in the routine of the small animal clinic. The etiology of the perianal fistula has not been elucidated so far. The diagnosis is clinical, and its treatment employs antibiotics, immunosuppressants. However, these medicines are not always efficient, and surgery becomes the only option. Side effects are frequent, and a complementary treatment plan must be evaluated. Homeopathy is a therapeutic technique suggested by the German physician Samuel Hahnemann and aims at healing through stimuli to the body's vital energy. This study aimed to report a perianal fistula occurrence in a dog of the French bulldog breed treated by homeopathy. Methods: Male dog, French bulldog breed, with the complaint of walking and sitting at all times associated with the frequent licking of the anus. After physical examination the diagnosis was perianal fistula. The treatment was based by -9 -6 homeopathy with injectable medicines Belladonna D9 (1x10 ) associated with Arnica montana D6 (1x10 ); Nitric acidum -60 -18 30CH (1x10 ); Hamamellis virginiana D18 (1x10 ). The patient showed clinical improvement right after the first application of the medication, decreasing the stimulus of pain and discomfort. Seventeen days after treatment initiation, the inflammatory process was resolved. Homeopathy has been proposed as a regulatory therapy with a natural tendency to rebalance vital energy and organic functions. The homeopathic medicines were chosen based on the law of similars, i.e., using highly diluted and energized medicines to treat the symptoms and diseases that these same substances, in ponderal doses, would cause in a healthy patient. The treatment here reported did not generate side effects and was effective in its purpose. Treatment time was short, and, additionally, the animal was followed up for eight months after treatment with no relevant clinical changes. Conclusion: The therapeutic protocol determined reestablished the function of the affected tissues with total resolution of the disease in 17 days, with no complications. New comparative and randomized studies must be carried out to better understand the efficacy of such therapy

Sign in / Sign up

Export Citation Format

Share Document