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Sample records for caribbean heart care

  1. Cirurgia cardíaca em uma sociedade multiétnica: a experiência do Caribbean Heart Care Cardiac surgery in a multi-ethnic low volume service: the Caribbean Heart Care Experience

    Directory of Open Access Journals (Sweden)

    Jose Burgos-Irazabal

    2005-09-01

    Full Text Available OBJETIVO: A população do Caribe constitui uma sociedade multiétnica, incluindo caucasianos, afro-caribenhos, indianos, asiáticos, hispânicos, europeus e nativos, com uma grande variabilidade de padrões socioeconômicos. A incidência e os tipos de doenças cardíacas também variam significativamente entre essas etnias. Relatamos aqui a experiência (em pacientes adultos e pediátricos em um serviço de cirurgia cardíaca de baixo volume em Trinidad e Tobago, no Caribe. MÉTODO: O programa de cirurgia cardíaca de adultos começou em novembro de 1993, são reportados os dados de 878 pacientes (629 homens, idade entre 18 e 88 anos, com média de 67 anos. Destes, 39,4% eram diabéticos e 46,5% hipertensos. Os procedimentos incluíram cirurgia de revascularização miocárdica (CRM, reparo e substituição de valvas e cirurgias da aorta. O programa de cirurgia cardíaca pediátrica (idades entre duas semanas e 21 anos começou em setembro de 1998, tendo sido realizado um total de 279 operações. RESULTADOS: Adultos - a mortalidade total foi de 3,8%. A maioria dos procedimentos foi CRM (82,3% com mortalidade total de 2,8% (0% em 2004. A técnica sem circulação extracorpórea foi empregada em 43% dos procedimentos de CRM (71,2% em 2004. A cirurgia de valva aórtica foi feita em 49 pacientes, e a substituição/reparo da valva mitral em 96 doentes. Pediátricos - a maioria dos procedimentos foi correção de comunicação interventricular (111, comunicação interatrial (57, tetralogia de Fallot (23, e 88 outros (com mortalidade de 1,5%. CONCLUSÃO: Cirurgia cardíaca em um serviço multiétnico de baixo volume pode ser realizada com excelentes resultados, comparáveis com padrões internacionais de qualidade.INTRODUCTION: The Caribbean is a multi-ethnic society, including Caucasian, Afro-Caribbean, East Indians, Asians, Hispanics, European and natives, which has a broad range of living standards. The incidence and types of heart diseases

  2. The Care Chain, Children's Mobility and the Caribbean Migration Tradition

    DEFF Research Database (Denmark)

    Olwig, Karen Fog

    2012-01-01

    . This leads to the suggestion that young adults’ migration for domestic work*which often builds on informal inter-personal social relations and offers the only means of migration for the many women who do not have access to more attractive forms of wage-labour migration*can be viewed as an extension......Children’s mobility is analysed in this article as an important foundation of the migration tradition that has been an integral aspect of most Caribbean societies. I show that, because of their position as dependents who are not yet fully socialised and who are subject to adult authority, children...... move, and are moved, relatively easily between varying social domains and households in different locations. This migration has created a Caribbeancare chain’ that has played an important role in the generating and reinforcing of local, regional and transnational networks of interpersonal relations...

  3. Heart failure - palliative care

    Science.gov (United States)

    ... with your doctors and loved ones may help bring you peace of mind. You may have already discussed heart transplantation and the use of a ventricular assist device with your doctor. At some point, you will ...

  4. Financing of health care in four Caribbean territories: a comparison with reforms in Europe.

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    Rutten, F; Lapré, R; Antonius, R; Dokoui, S; Haqq, E; Roberts, R; Mills, A

    2002-10-01

    This paper considers health care finance in four Caribbean territories and plans for reform in comparison with developments in European countries, to which these territories are historically linked. European health care reforms are aimed at making resource allocation in health care more efficient and more responsive to consumers' demands and preferences. These reforms in Europe have been continuing without appearing to have influenced the developments in the Caribbean very much, except in Martinique. In Trinidad and Tobago current reform entails delegation of responsibility for providing services to four regional health authorities and no purchaser/provider split at the regional or facility level as in the UK has been implemented. In the Bahamas, managed care arrangements are likely to emerge given the proximity of the United States. Recent universal coverage reform in Martinique was aimed at harmonisation of finance by bringing social security and social aid functions together under one management structure and may provide more opportunities for contracting and other initiatives towards greater efficiency. The first priority in Suriname is to restore proper functioning of the current system. Reforms in the four Caribbean territories have a largely administrative character and affect the organisation of the third party role in health care rather than fundamentally changing the relationship between this third party and the various other parties in health care.

  5. Heart Failure Care in General Practice

    NARCIS (Netherlands)

    Valk, M.J.M.

    2017-01-01

    Heart failure (HF) is an increasing health care problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the health care team is considered optimal. HF management has improved substantially over the last two decades, mainly for patients with HF with a reduced ejection

  6. Gaps In Primary Care And Health System Performance In Six Latin American And Caribbean Countries.

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    Macinko, James; Guanais, Frederico C; Mullachery, Pricila; Jimenez, Geronimo

    2016-08-01

    The rapid demographic and epidemiological transitions occurring in Latin America and the Caribbean have led to high levels of noncommunicable diseases in the region. In addition to reduced risk factors for chronic conditions, a strong health system for managing chronic conditions is vital. This study assessed the extent to which populations in six Latin American and Caribbean countries receive high-quality primary care, and it examined the relationship between experiences with care and perceptions of health system performance. We applied a validated survey on access, use, and satisfaction with health care services to nationally representative samples of the populations of Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama. Respondents reported considerable gaps in the ways in which primary care is organized, financed, and delivered. Nearly half reported using the emergency department for a condition they considered treatable in a primary care setting. Reports of more primary care problems were associated with worse perceptions of health system performance and quality and less receipt of preventive care. Urgent attention to primary care performance is required as the region's population continues to age at an unprecedented rate. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Dopamine in heart failure and critical care

    NARCIS (Netherlands)

    Smit, AJ

    Dopamine is widely used in critical care to prevent renal function loss. Nevertheless sufficient evidence is still lacking of reduction in end points like mortality or renal replacement therapy. Dopaminergic treatment in chronic heart failure (CHF) has provided an example of unexpected adverse

  8. Health care technology transfer in Latin America and the Caribbean

    NARCIS (Netherlands)

    Coe, G.A.; Banta, H.D.

    1992-01-01

    The greatest problem concerning health care technology for developing countries is that they are dependent upon the industrialized world for technology. The only short-term solution to this problem is to improve the choices that are available to them. This goal will require changes in the structure

  9. Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean.

    Science.gov (United States)

    Oldenburger, David; De Bortoli Cassiani, Silvia Helena; Bryant-Lukosius, Denise; Valaitis, Ruta Kristina; Baumann, Andrea; Pulcini, Joyce; Martin-Misener, Ruth

    2017-06-08

    SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

  10. ANESTHESIA AND INTENSIVE CARE IN HEART RETRANSPLANTATION

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    V. N. Poptsov

    2011-01-01

    Full Text Available In this review we describe our own experience of anesthetic management and early intensive care of two patients after heart retransplantation. As shown in this article, preretransplant clinical condition (severity of organs dys- function influences on character of intra- and postoperative periods including duration of anesthesia, surgery, postoperative ventilation and ICU stay, intra- and postoperative bleeding, volume of blood product transfusion, infection complications, need in renal replacement therapy, selective LPS-adsorption and other therapeutic op- tions. 

  11. Contextualizing Genetics for Regional Heart Failure Care.

    Science.gov (United States)

    Iyngkaran, Pupalan; Thomas, Merlin C; Johnson, Renee; French, John; Ilton, Marcus; McDonald, Peter; Hare, David L; Fatkin, Diane

    Congestive heart failure (CHF) is a chronic and often devastating cardiovascular disorder with no cure. There has been much advancement in the last two decades that has seen improvements in morbidity and mortality. Clinicians have also noted variations in the responses to therapies. More detailed observations also point to clusters of diseases, phenotypic groupings, unusual severity and the rates at which CHF occurs. Medical genetics is playing an increasingly important role in answering some of these observations. This developing field in many respects provides more information than is currently clinically applicable. This includes making sense of the established single gene mutations or uncommon private mutations. In this thematic series which discusses the many factors that could be relevant for CHF care, once established treatments are available in the communities; this section addresses a contextual role for medical genetics.

  12. Congenital Heart Disease: Guidelines of Care for Children with Special Health Care Needs.

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    Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

    These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…

  13. 'We are doing our best': African and African-Caribbean fatherhood, health and preventive primary care services, in England.

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    Williams, Robert; Hewison, Alistair; Stewart, Mel; Liles, Clive; Wildman, Stuart

    2012-03-01

    Recent policy pronouncements emphasise the importance of engaging fathers with preventive primary care services. However, in England, there is a paucity of literature which examines African and African-Caribbean fathers' experiences of service provision. This paper reports a study that investigated African and African-Caribbean fathers' beliefs about fatherhood, health and preventive primary care services, with the aim of addressing the deficit in the literature. Nine focus groups involving 46 African and African-Caribbean fathers, recruited using purposive sampling, were undertaken between October 2008-January 2009. Fatherhood was seen as a core aspect of the participants' identities. The fathers enacted these identities in a number of ways, such as caring for and protecting children, which were influenced by spirituality, relationships with women, paid work and racism. The fathers had concerns about their bodies, medical conditions, physical activity and forms of consumption. However, their primary focus was on maintaining and improving the well-being of their children. This resulted in them neglecting their own health needs as they had to meet the obligations of family life and paid work. The fathers reported limited contact with preventive primary care services and were unaware of their purpose, function and availability. They identified ethnicity as a positive asset, and felt their families and communities had particular strengths. However they acknowledged that structural constraints, including racism, influenced their perceptions of and access to local health services. The engagement of African and African-Caribbean fathers needs to be addressed more specifically in policy as part of a broader programme of action to tackle health inequalities. In addition, child health services could build on fathers' commitment to children's well-being through practice that addresses fathers' as well as mothers' needs in families. © 2011 Blackwell Publishing Ltd.

  14. Gram-Negative Infections in Adult Intensive Care Units of Latin America and the Caribbean

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    Carlos M. Luna

    2014-01-01

    Full Text Available This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs. A systematic search of the biomedical literature (PubMed was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%. Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs.

  15. Health care professionals in a heart failure team

    NARCIS (Netherlands)

    Jaarsma, T

    2005-01-01

    A heart failure team that treats heart failure patients often faces the challenge of managing multiple conditions requiring multiple medications and life style changes in an older patient group. A multidisciplinary team approach can optimally diagnose, carefully review and prescribe treatment, and

  16. Peri-operative care in adults with congenital heart disease : Room for improvement in after care

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    Schoormans, D.; Smets, E.M.A.; Zwart, R.; Sprangers, M.A.G.; Veelenturg, T.H.; de Mol, B.A.; Hazekamp, M.G.; Koolbergen, D.R.; Sojak, V.; Bouma, B.J.; Groenink, M.; Boekholdt, M.S.; Backx, A.P.; Mulder, B.J.

    2013-01-01

    Patient satisfaction with care has received little attention within the field of congenital heart disease. Our objective was to examine patient satisfaction with the care received when undergoing open-heart surgery in order to identify the best and worst aspects of peri-operative care. Moreover, we

  17. Peri-operative care in adults with congenital heart disease: room for improvement in after care

    NARCIS (Netherlands)

    Schoormans, Dounya; Smets, Ellen M. A.; Zwart, Ronald; Sprangers, Mirjam A. G.; Veelenturg, Tonny H. M.; de Mol, Bas A. J. M.; Hazekamp, Mark G.; Koolbergen, Dave R.; Sojak, Vladimir; Bouma, Berto J.; Groenink, Maarten; Boekholdt, Matthijs S. M.; Backx, Ad P. C. M.; Mulder, Barbara J. M.

    2013-01-01

    Patient satisfaction with care has received little attention within the field of congenital heart disease. Our objective was to examine patient satisfaction with the care received when undergoing open-heart surgery in order to identify the best and worst aspects of peri-operative care. Moreover, we

  18. Childhood Heart Disease - A partnership model of integrated care

    OpenAIRE

    Williams, Holly; Brooke, Mark

    2018-01-01

    HeartKids is a national charity supporting infants, children, young people and adults living with or impacted by congenital / childhood heart disease. For over 20 years HeartKids has worked in partnership with Lady Cilento Children's Hospital to deliver services and support to families.HeartKids supports families in hosptial and in the commuity with a suite of support programs lead by both health profesisonals and volunteers.  Critical to our model of care is a partnership with Lady Cilento C...

  19. Self-care in heart failure patients 1

    Science.gov (United States)

    da Conceição, Ana Paula; dos Santos, Mariana Alvina; dos Santos, Bernardo; da Cruz, Diná de Almeida Lopes Monteiro

    2015-01-01

    Abstract Objective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients. Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05. Results: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007). Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement. PMID:26444158

  20. Individualizing the care of older heart failure patients.

    Science.gov (United States)

    Heckman, George A; McKelvie, Robert S; Rockwood, Kenneth

    2018-03-01

    The heart failure epidemic is driven mainly by population aging and the improving survival of patients with cardiovascular risk factors. Aging heart failure patients are affected by multiple concurrent comorbidities and geriatric syndromes, the most important of which are frailty and cognitive impairment. The purpose of this review is to provide clinicians with practical advice on how to individualize the care of older heart failure patients. Frailty and cognitive impairment are common in older heart failure patients. Frailty is increasingly recognized as a key risk factor for functional decline, health service utilization and mortality in aging heart failure patients. Similarly, cognitive impairment impairs patients' ability for self-care and leads to adverse outcomes. Simple and efficient instruments exist to screen for these conditions. Heart failure patients who are frail or cognitively impaired are best looked after in a disease management setting that is deployed in a more integrated healthcare system with access to specialized geriatric consultants. Optimal care planning requires knowledge of these conditions as well as patient and caregiver engagement. Frailty and cognitive impairment are central features of the heart failure syndrome in aging patients and should be routinely considered in assessment and care planning.

  1. Self-care in Patients with Heart Failure

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    Maria do Céu Mendes Pinto Marques

    2016-04-01

    Full Text Available Objectives: To adapt the Self-Care of Heart Failure Index V6.2 to Portuguese and analyze self-care capability in maintenance, management and self-confidence in patients with heart failure attending nursing care services at two Portuguese hospitals. Method: Exploratory study, sample of 110 patients who attended the nursing care service for patients with heart failure at two Portuguese hospitals, carried out over a six-month period. Descriptive statistics and psychometric tests were used. Results: Internal consistency similar to the original scale. The patients consisted mostly of older adults with low self-care literacy, low values associated with physical activity and salt control in meals taken outside the home, and inadequate control of signs and symptoms. Conclusion: Patients present difficulties in maintenance and management of the disease, and are self-confident regarding it. This instrument enables individualized assessment leading to decision-making and adjusted action.

  2. Heart failure care for patients who do not speak English.

    Science.gov (United States)

    Brennan, Emma Jane

    Heart failure affects 1-2% of the UK population with prevalence rates predicted to rise over the next decade. Ineffective education for patients with heart failure can lead to a failure to adhere to guidance, reduced self-care and increased hospital readmissions. The National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) have issued clear guidelines on patient-centred care in heart failure, particularly in relation to patients' cultural and linguistic needs. Patients with heart failure should have access to an interpreter or advocate if needed. Furthermore, heart failure educational materials should be tailored to suit the individual and be accessible to people who do not speak or read English. This article explores the practice recommendations for these patients with heart failure and provides an overview of current guidelines associated with optimal patient outcomes. It also includes practical advice on translation services, and information and educational materials available for patients with heart failure who do not speak English.

  3. Management considerations in the care of elderly heart failure patients in long-term care facilities.

    Science.gov (United States)

    Heckman, George A; Boscart, Veronique M; McKelvie, Robert S

    2014-07-01

    Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.

  4. Areas for quality improvements in heart failure care: quality of care from the patient's perspective.

    Science.gov (United States)

    Ängerud, Karin H; Boman, Kurt; Ekman, Inger; Brännström, Margareta

    2017-12-01

    Heart failure is a serious condition with high mortality and a high symptom burden. Most patients with heart failure will be taken care of in primary care but the knowledge of how the quality of care is perceived by patients with heart failure is limited. The aim was to explore how patients with heart failure report quality of care, in an outpatient setting. Seventy-one patients with a confirmed diagnosis of heart failure and who were cared for in an outpatient setting were included in this cross-sectional study. Quality of care was assessed with a short form of the Quality from the Patient's Perspective questionnaire. The items measured four dimensions, and each item consists of both perceived reality of the received care and its subjective importance. Inadequate quality was identified in three out of four dimensions and in items without dimension affiliation. In total, inadequate quality was identified in 19 out of 25 items. Patients reported the highest level of perceived reality in 'my family member was treated well' and the lowest perceived reality in 'effective treatment for loss of appetite'. Effective treatment for shortness of breath was of the highest subjective importance for the patients. Important areas for improvement in the quality of care for patients with heart failure in an outpatient setting were identified, such as symptom alleviation, information, participation and access to care. © 2016 Nordic College of Caring Science.

  5. HeartCare+: A Smart Heart Care Mobile Application for Framingham-Based Early Risk Prediction of Hard Coronary Heart Diseases in Middle East

    Directory of Open Access Journals (Sweden)

    Hoda Ahmed Galal Elsayed

    2017-01-01

    Full Text Available Background. Healthcare is a challenging, yet so demanding sector that developing countries are paying more attention to recently. Statistics show that rural areas are expected to develop a high rate of heart diseases, which is a leading cause of sudden mortality, in the future. Thus, providing solutions that can assist rural people in detecting the cardiac risks early will be vital for uncovering and even preventing the long-term complications of cardiac diseases. Methodology. Mobile technology can be effectively utilized to limit the cardiac diseases’ prevalence in rural Middle East. This paper proposes a smart mobile solution for early risk detection of hard coronary heart diseases that uses the Framingham scoring model. Results. Smart HeartCare+ mobile app estimates accurately coronary heart diseases’ risk over 10 years based on clinical and nonclinical data and classifies the patient risk to low, moderate, or high. HeartCare+ also directs the patients to further treatment recommendations. Conclusion. This work attempts to investigate the effectiveness of the mobile technology in the early risk detection of coronary heart diseases. HeartCare+ app intensifies the communication channel between the lab workers and patients residing in rural areas and cardiologists and specialist residing in urban places.

  6. Update on ischemic heart disease and intensive cardiac care.

    Science.gov (United States)

    Sionis, Alessandro; Ruiz-Nodar, Juan Miguel; Fernández-Ortiz, Antonio; Marín, Francisco; Abu-Assi, Emad; Díaz-Castro, Oscar; Nuñez-Gil, Ivan J; Lidón, Rosa-Maria

    2015-03-01

    This article summarizes the main developments reported in 2014 on ischemic heart disease, together with the most important innovations in intensive cardiac care. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Palliative care in heart failure : a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

    NARCIS (Netherlands)

    Jaarsma, Tiny; Beattie, James M.; Ryder, Mary; Rutten, Frans H.; McDonagh, Theresa; Mohacsi, Paul; Murray, Scott A.; Grodzicki, Thomas; Bergh, Ingrid; Metra, Marco; Ekman, Inger; Angermann, Christiane; Leventhal, Marcia; Pitsis, Antonis; Anker, Stefan D.; Gavazzi, Antonello; Ponikowski, Piotr; Dickstein, Kenneth; Delacretaz, Etienne; Blue, Lynda; Strasser, Florian; McMurray, John

    Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as

  8. European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

    NARCIS (Netherlands)

    McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlstroem, Ulf; Ekman, Inger; Lainscak, Mitja; McDonald, Kenneth; Ryder, Mary; Stroemberg, Anna; Jaarsma, Tiny

    The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This

  9. Ultrasound for critical care physicians: hungry heart

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    Villalobos N

    2016-01-01

    Full Text Available No abstract available. Article truncated after 150 words. A 31-year-old incarcerated man with a past medical history of intravenous drug use and hepatitis C, presented with a one week history of dry, non-productive cough, orthopnea and exertional dyspnea. He denied current intravenous drug use, and endorsed that the last time he used was before he was incarcerated over 3 years ago, his last tattoo was in prison, 6 months prior. He was found to have an oxygen saturation of 77% on room air, fever of 40º C, heart rate of 114 bpm, and blood pressure of 80/50 mmHg. The patient had a leukocytosis of 14 x109/L, and a chest x-ray demonstrating patchy airspace disease. Blood cultures were sent and he was treated with antibiotics and vasopressors for septic shock. The patient was intubated for acute hypoxemic respiratory failure secondary to multifocal pneumonia. A bedside transthoracic echocardiogram was performed. What is the likely diagnosis supported by the echocardiogram? 1. ...

  10. Adherence to self-care in patients with heart failure in the HeartCycle study.

    Science.gov (United States)

    Stut, Wim; Deighan, Carolyn; Cleland, John G; Jaarsma, Tiny

    2015-01-01

    The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient. The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system's database. Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101) improved during the study for daily weighing, low-salt diet, physical activity (Pmeasuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%. Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was high and remained stable over time. However, adherence to daily reporting of symptoms was lower and declined in the long-term.

  11. Skilled Nursing Facility Care for Patients With Heart Failure: Can We Make It "Heart Failure Ready?"

    Science.gov (United States)

    Orr, Nicole M; Boxer, Rebecca S; Dolansky, Mary A; Allen, Larry A; Forman, Daniel E

    2016-12-01

    Skilled nursing facilities (SNFs) have emerged as an integral component of care for older adults with heart failure (HF). Despite their prominent role, poor clinical outcomes for the medically complex patients with HF managed in SNFs are common. Barriers to providing quality care include poor transitional care during hospital-to-SNF and SNF-to-community discharges, lack of HF training among SNF staff, and a lack of a standardized care process among SNF facilities. Although no evidence-based practice standards have been established, various measures and tools designed to improve HF management in SNFs are being investigated. In this review, we discuss the challenges of HF care in SNFs as well as potential targets and recommendations that can help improve care with respect to transitions, HF management within SNFs, and modifiable factors within facilities. Policy considerations that might help catalyze improvements in SNF-based HF management are also discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries

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    Joyce E Thompson

    2015-05-01

    Full Text Available OBJECTIVE: To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC to 1 better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2 determine the need for more rigorous study of the issues. METHODS: A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. RESULTS: Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. CONCLUSIONS: The findings suggest that 1 the quality of maternal and newborn care and 2 the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

  13. Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression.

    Science.gov (United States)

    Adams, A; Vail, L; Buckingham, C D; Kidd, J; Weich, S; Roter, D

    2014-09-01

    This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries

  14. Self-Care Among Older Adults With Heart Failure

    Directory of Open Access Journals (Sweden)

    Sumayya Attaallah MSN, RN

    2016-12-01

    Full Text Available Background: It is estimated that 5.7 million Americans are living with heart failure (HF today. Despite the fact that HF is one of the most common reasons people aged 65 years and older are admitted into the hospital, few studies describe the self-care in this older adult population. Purpose: The purpose of the study was to review the current literature on self-care in this population to better understand the influence of selected factors on self-care and health outcomes. Methods: A literature search was completed and resulted in including 28 studies. Results: Multiple factors have been reported as barriers to self-care including depression and presence of peripheral arterial disease. Factors having a positive effect on self-care are male gender, number of cardiologist referrals, and self-efficacy. There were few studies that described the association between cognitive functioning and self-care. There is a lack of strong evidence to support the association between self-care and health outcomes such as readmission rate, but recent studies suggest that a 30-day readmission is not a valid predictor of health outcomes. Implications: The assessment of the psychological factors and health care resource utilization patterns that may influence self-care is recommended. More research that addresses the role of cognitive factors in influencing self-care is needed.

  15. Cognitive impairment and self-care in heart failure

    Directory of Open Access Journals (Sweden)

    Hajduk AM

    2013-10-01

    Full Text Available Alexandra M Hajduk,1,2 Stephenie C Lemon,3 David D McManus,1,2,4 Darleen M Lessard,1 Jerry H Gurwitz,1,2,4 Frederick A Spencer,5 Robert J Goldberg,1,2 Jane S Saczynski1,2,4 1Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; 2Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA; 3Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 4Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; 5Department of Medicine, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF. Design: Prospective cohort study. Setting and participants: A total of 577 patients (mean age = 71 years, 44% female hospitalized for HF at five medical centers in the United States and Canada. Measurements and methods: Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function using standardized measures. Patients' demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors. Results: A total of 453 patients (79% were impaired in at least one cognitive

  16. [Heart failure in primary care: Attitudes, knowledge and self-care].

    Science.gov (United States)

    Salvadó-Hernández, Cristina; Cosculluela-Torres, Pilar; Blanes-Monllor, Carmen; Parellada-Esquius, Neus; Méndez-Galeano, Carmen; Maroto-Villanova, Neus; García-Cerdán, Rosa Maria; Núñez-Manrique, M Pilar; Barrio-Ruiz, Carmen; Salvador-González, Betlem

    2017-06-23

    To determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. Cross-sectional and multicentre study. Primary Care. Subjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. Self-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. A total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R 2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: -1.37; -1.85 to -0.90), and coronary heart disease diagnosis (-2.41; -4.36: -0.46). Self-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  17. Construct validity of the Heart Failure Screening Tool (Heart-FaST) to identify heart failure patients at risk of poor self-care: Rasch analysis.

    Science.gov (United States)

    Reynolds, Nicholas A; Ski, Chantal F; McEvedy, Samantha M; Thompson, David R; Cameron, Jan

    2018-02-14

    The aim of this study was to psychometrically evaluate the Heart Failure Screening Tool (Heart-FaST) via: (1) examination of internal construct validity; (2) testing of scale function in accordance with design; and (3) recommendation for change/s, if items are not well adjusted, to improve psychometric credential. Self-care is vital to the management of heart failure. The Heart-FaST may provide a prospective assessment of risk, regarding the likelihood that patients with heart failure will engage in self-care. Psychometric validation of the Heart-FaST using Rasch analysis. The Heart-FaST was administered to 135 patients (median age = 68, IQR = 59-78 years; 105 males) enrolled in a multidisciplinary heart failure management program. The Heart-FaST is a nurse-administered tool for screening patients with HF at risk of poor self-care. A Rasch analysis of responses was conducted which tested data against Rasch model expectations, including whether items serve as unbiased, non-redundant indicators of risk and measure a single construct and that rating scales operate as intended. The results showed that data met Rasch model expectations after rescoring or deleting items due to poor discrimination, disordered thresholds, differential item functioning, or response dependence. There was no evidence of multidimensionality which supports the use of total scores from Heart-FaST as indicators of risk. Aggregate scores from this modified screening tool rank heart failure patients according to their "risk of poor self-care" demonstrating that the Heart-FaST items constitute a meaningful scale to identify heart failure patients at risk of poor engagement in heart failure self-care. © 2018 John Wiley & Sons Ltd.

  18. [Galician study of heart failure in primary care (GALICAP Study)].

    Science.gov (United States)

    Otero-Raviña, Fernando; Grigorian-Shamagian, Lilian; Fransi-Galiana, Luis; Názara-Otero, Carlos; Fernández-Villaverde, José M; del Alamo-Alonso, Alberto; Nieto-Pol, Enrique; de Santiago-Boullón, Miguel; López-Rodríguez, Isidro; Cardona-Vidal, José M; Varela-Román, Alfonso; González-Juanatey, José R

    2007-04-01

    Heart failure (HF) is an important public health concern. Our aim was to evaluate the characteristics of HF patients in Galicia, Spain. This descriptive, cross-sectional, multicenter study involved 149 primary care physicians and recorded the characteristics of 1195 patients diagnosed with HF. Some 48% of patients were male, and their mean age was 76 years, though women were older (P<.001). Disease history included hypertension in 82%, hyperlipidemia in 47%, diabetes in 31%, atrial fibrillation in 49%, valvular disease in 35%, and ischemic heart disease in 32%. Mean systolic and diastolic blood pressures were 131 mm Hg and 76 mm Hg, respectively. Pressure was controlled (heart disease, more frequently in males than females (P<.001). The most commonly prescribed drugs were diuretics (82%), angiotensin-converting enzyme (ACE) inhibitors (48%), angiotensin II receptor antagonists (29%), and beta-blockers (27%). Patients with depressed systolic function were more frequently prescribed beta-blockers (P<.001), ACE inhibitors (P<.01), and antialdosterones (P<.05). During the last year, 57% of patients had been admitted to hospital, of whom 45% were admitted for cardiovascular reasons. The most prevalent form of HF in Galicia was HF with preserved systolic function, which was mostly associated with high blood pressure due to poor control. In patients with ischemic heart disease, the use of coronary angiography was influenced by sex. Drug treatment was suboptimal. Intervention programs are required to improve care in these patients.

  19. Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life.

    Science.gov (United States)

    Hammond, Wizdom Powell; Mohottige, Dinushika; Chantala, Kim; Hastings, Julia F; Neighbors, Harold W; Snowden, Lonnie

    2011-02-01

    The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n=551) and Caribbean Black men (n=1,217). We used the 2001-2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.

  20. Determinants of Usual Source of Care Disparities among African American and Caribbean Black Men: Findings from the national Survey of american life

    Science.gov (United States)

    Hammond, Wizdom Powell; Mohottige, Dinushika; Chantala, Kim; Hastings, Julia F.; Neighbors, Harold W.; Snowden, Lonnie

    2011-01-01

    Purpose The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n5551) and Caribbean Black men (n51,217). Methods We used the 2001–2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. Results Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. Conclusions Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men. PMID:21317513

  1. Palliative care among heart failure patients in primary care: a comparison to cancer patients using English family practice data.

    Directory of Open Access Journals (Sweden)

    Amy Gadoud

    Full Text Available Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level.This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care.Among patients with heart failure, 7% (234/3 122 were entered on the palliative care register compared to 48% (3 669/7 608 of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234 were entered onto the register within a week of their death.This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory.

  2. Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.

    Science.gov (United States)

    Chang, Leslie L; DeVore, Adam D; Granger, Bradi B; Eapen, Zubin J; Ariely, Dan; Hernandez, Adrian F

    2017-08-22

    Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF). Given its increasing prevalence and high associated cost of care, HF is a paradigm case for studying novel approaches to improve health care; therefore, if we can better understand why patients with HF make the choices they do, then we may be more poised to help them manage their medications, influence daily behaviors, and encourage healthy decision making. In this article, we will give a brief explanation of the core behavioral economics concepts that apply to patients with HF. We will also examine how to craft these concepts into tools such as financial incentives and social networks that may improve the management of patients with HF. We believe that behavioral economics can help us understand barriers to change, encourage positive behaviors, and offer additional approaches to improving the outcomes of patients with HF. © 2017 American Heart Association, Inc.

  3. Diastolic heart failure in anaesthesia and critical care

    NARCIS (Netherlands)

    Pirracchio, R.; Cholley, B.; de Hert, S.; Solal, A. Cohen; Mebazaa, A.

    2007-01-01

    Diastolic heart failure is an underestimated pathology with a high risk of acute decompensation during the perioperative period. This article reviews the epidemiology, risk factors, pathophysiology, and treatment of diastolic heart failure. Although frequently underestimated, diastolic heart failure

  4. Proposed policies on palliative care for elderly people in Latin America and the Caribbean

    Directory of Open Access Journals (Sweden)

    Jose F. Parodi

    2016-03-01

    Full Text Available The fast aging of population, epidemiological changes and the need to guarantee human rights (health, social protection,etc. force countries and the wider community to become aware and develop policies that form the basis for an strategy of maintaining the health and care of elderly people. This should be designed taking into account the particularities of this age group, and the need for adaptation of social health services to provide quality care and equity. The adequacy of services involves recognizing the new requirements, the particularities of the risks and problems of this stage of life, comprehensive care, and even decent evidence-based on the end of life. In the presence of new problems and new goals, new skills, new work scenarios and an information system that improve the efficiency and quality of interventions are required

  5. A guide for identification and continuing care of adult congenital heart disease patients in primary care.

    Science.gov (United States)

    Ellison, S; Lamb, J; Haines, A; O'Dell, S; Thomas, G; Sethi, S; Ratcliffe, J; Chisholm, S; Vaughan, J; Mahadevan, V S

    2013-03-10

    Surgical and other advances in the treatment and care of congenital heart disease have resulted in a significant increase in the number of adults with congenital heart disease (ACHD), many of whom have no regular cardiology follow-up. Optimised care for ACHD patients requires continuity of specialist and shared care and education of practitioners and patients. The challenges for managing ACHD were identified by a Health Needs Assessment in the North West and are addressed within the UK Department of Health's ACHD Commissioning Guide. An ACHD model of care was recommended in the North West of England and developed by the three North West Cardiac & Stroke Networks. Within this, a Task Group focused on the role of primary care in the identification and continuing care of ACHD patients. A feasibility study demonstrated that existing diagnostic Read Codes can identify ACHD patients on general practice registers. An ACHD Toolkit was developed to provide algorithms to guide the appropriate management of ACHD patients through primary, secondary and/or specialist ACHD care and to improve education/knowledge amongst primary care staff about ACHD and its wider implications. Early findings during the development of this Toolkit illustrate a wide disparity of provision between current and optimal management strategies. Patients lost to follow-up have already been identified and their management modified. By focusing on identifying ACHD patients in primary care and organising/delivering ACHD services, the ACHD Toolkit could help to improve quality, timeliness of care, patient experience and wellbeing. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. [Management of heart failure in cardiology and primary care (MICCAP) program: Improving the management of patients with heart failure].

    Science.gov (United States)

    Barrios, V; Escobar, C; Pallares, V; Egocheaga, M I; Lobos, J M; Bover, R; Gómez Doblas, J J; Cosín, J

    2018-03-26

    Despite current treatments, morbidity and mortality of patients with heart failure remain high. The late diagnosis of heart failure, the insufficient heart failure treatment (i.e. not using the appropriate drugs, prescribing lower doses of drugs than recommended, etc.), and a poor coordination between different health care levels, may explain, at least in part, these figures. The Management of Heart Failure in Cardiology and Primary Care (MICCAP) program has been developed with the aim of optimising the integrated management of patients with heart failure between Primary Care and Cardiology, through the improvement of coordination between both health care levels. This includes continuous medical education to reinforce the diagnostic and therapeutic skills of general practitioners in the field of heart failure. The rationale and objectives of the MICCAP program are summarised in this article. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Home Health Care With Telemonitoring Improves Health Status for Older Adults with Heart Failure

    Science.gov (United States)

    Madigan, Elizabeth; Schmotzer, Brian J.; Struk, Cynthia J.; DiCarlo, Christina M.; Kikano, George; Piña, Ileana L.; Boxer, Rebecca S.

    2014-01-01

    Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalizations or emergency visits between those who received a telemonitoring vs. usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore for older adults with heart failure telemonitoring may be important adjunct to home health care services to improve health status. PMID:23438509

  8. Clinical Updates in Women's Health Care Summary: Ischemic Heart Disease: Primary and Preventive Care Review.

    Science.gov (United States)

    Fuller, Brittany S; Carlyle, Lynn; Voeltz, Michele D

    2017-11-01

    Cardiovascular disease is the leading cause of death among women in the United States. Obstetrician-gynecologists often are the sole health care providers for otherwise healthy women. Therefore, they must be aware of risk factors, signs, and symptoms of cardiovascular disease and be prepared to recognize and treat this condition in patients as well as provide referrals when specialized care is indicated. Women with cardiac problems typically present with chest discomfort; however, they also are more likely than healthy women to present with other common symptoms, such as shortness of breath, back pain, jaw pain, or nausea and vomiting. This monograph, with a primary focus on ischemic heart disease (IHD), discusses the basic anatomy of the heart and coronary arteries; vascular biology; pathogenesis of atherosclerosis; and the screening, prevention, diagnosis, and treatment of IHD as well as the multiple risk factors associated with the development of IHD that contribute to both increased morbidity and mortality.

  9. Caregiver Contribution to Heart Failure Self-Care (CACHS).

    Science.gov (United States)

    Harkness, Karen; Buck, Harleah G; Arthur, Heather; Carroll, Sandra; Cosman, Tammy; McGillion, Michael; Kaasalainen, Sharon; Kryworuchko, Jennifer; O'Keefe-McCarthy, Sheila; Sherifali, Diana; Strachan, Patricia H

    2016-01-01

    While caregivers (CGs) make an important contribution to the self-care of heart failure (HF) patients, there are no reliable and valid tools for measuring such contributions. Current interventions that strive to optimize patient outcomes through self-care strategies neglect to account for CG contributions, a potential confounder on outcomes. The aim of the study was to develop an instrument that measures CG contributions to HF patients' self-care. The study design follows an established process for instrument development. A systematic literature review and semi-structured interviews of CGs were conducted to identify measureable CG activities. Items were derived from thematic analysis of CG narratives. A content validity index was computed for each item (I-CVI). Items with an I-CVI of >0·70 were retained. Items with an I-CVI of 0·50-0·70 were revised for clarification and items with an I-CVI <0·5 were discarded, except in instances where fulsome theoretical or empirical evidence supported their retention. 14 CGs completed interviews and 10 CGs with 4 expert nurses completed I-CVI testing. Major interview themes included arranging appointments, medication adherence, monitoring, coordinating care, encouraging independence and taking action. A total of 36 items were constructed and underwent I-CVI testing. Following I-CVI testing, 27 items were retained, seven items were retained after revision based on CG feedback and two items were removed. This newly developed 34-item questionnaire represents current literature, CGs' experiences, excellent I-CVI scores and ready for further psychometric testing.

  10. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  11. Heart Failure: Self-care to Success: Development and evaluation of a program toolkit.

    Science.gov (United States)

    Bryant, Rebecca

    2017-08-17

    The Heart Failure: Self-care to Success toolkit was developed to assist NPs in empowering patients with heart failure (HF) to improve individual self-care behaviors. This article details the evolution of this toolkit for NPs, its effectiveness with patients with HF, and recommendations for future research and dissemination strategies.

  12. Caribbean Music.

    Science.gov (United States)

    Dean, Kris

    1991-01-01

    The Caribbean is a rich breeding ground for African-derived music. A synopsis is given of the music of the following countries and styles: (1) Jamaica; (2) Trinidad and Tobago; (3) Calypso; (4) steel pan; (5) Haiti; (6) Dominican Republic; (7) Cuba; (8) Puerto Rico; and (9) other islands. (SLD)

  13. Dental care for patients with heart failure: an update.

    Science.gov (United States)

    Herman, Wayne W; Ferguson, Henry W

    2010-07-01

    Heart failure (HF) is a common clinical syndrome that affects an estimated 5.7 million Americans. It is a growing health problem, particularly in people 65 years or older. Therefore, the probability that dental practitioners will have patients who have HF is increasing. The authors reviewed medical literature from 2000 through 2009 to determine the incidence, classifications, pathophysiology and advances in the medical diagnosis and treatment of HF. They also reviewed available dental literature during the same period to formulate treatment recommendations for dental care of people who have HF. Medicine has made advances in understanding and treating HF. These advances have resulted in the development of revised classification systems, a more structured approach to patient assessment and improved therapeutic options. Dentists need to be aware of advances in the diagnosis and treatment of HF. Keeping in mind the potential for morbidity in patients who have HF, identifying and accurately assessing these patients is imperative for clinical management. Often it is necessary for dentists to consult with patients' physicians to coordinate care and determine whether treatment can be rendered appropriately in a routine dental setting or whether advanced support, monitoring or both are necessary.

  14. Social support predicts self-care confidence in patients with heart failure.

    Science.gov (United States)

    Fivecoat, Hayley C; Sayers, Steven L; Riegel, Barbara

    2018-03-01

    Self-care for patients with heart failure includes engaging in behaviours that maintain medical stability and manage problematic symptoms, as well as the confidence in one's ability to carry out such behaviours. Given the social context of self-care behaviours in heart failure, there has been increasing interest in social support as a predictor of self-care. The goal of the present study was to examine the role of social support in self-care across time for persons with heart failure. Using data from an observational study of patients with chronic heart failure ( n = 280), we examined the role of three types of support - instrumental support, emotional support and assistance with self-care - in the longitudinal course of self-care maintenance, management and confidence. Self-report questionnaire data were collected at baseline and at three and six months later. We found that instrumental and emotional support predicted better self-care confidence on average and that self-care confidence improved at a faster rate for those with less instrumental support. Emotional support was positively associated with self-care management and self-care confidence, and assistance with self-care was positively associated with self-care maintenance. These findings highlight the contribution of social support to self-care in heart failure and provide guidance for future family-based interventions to improve self-care.

  15. Understanding palliative care on the heart failure care team: an innovative research methodology.

    Science.gov (United States)

    Lingard, Lorelei A; McDougall, Allan; Schulz, Valerie; Shadd, Joshua; Marshall, Denise; Strachan, Patricia H; Tait, Glendon R; Arnold, J Malcolm; Kimel, Gil

    2013-05-01

    There is a growing call to integrate palliative care for patients with advanced heart failure (HF). However, the knowledge to inform integration efforts comes largely from interview and survey research with individual patients and providers. This work has been critically important in raising awareness of the need for integration, but it is insufficient to inform solutions that must be enacted not by isolated individuals but by complex care teams. Research methods are urgently required to support systematic exploration of the experiences of patients with HF, family caregivers, and health care providers as they interact as a care team. To design a research methodology that can support systematic exploration of the experiences of patients with HF, caregivers, and health care providers as they interact as a care team. This article describes in detail a methodology that we have piloted and are currently using in a multisite study of HF care teams. We describe three aspects of the methodology: the theoretical framework, an innovative sampling strategy, and an iterative system of data collection and analysis that incorporates four data sources and four analytical steps. We anticipate that this innovative methodology will support groundbreaking research in both HF care and other team settings in which palliative integration efforts are emerging for patients with advanced nonmalignant disease. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  16. MANAGEMENT OF CHRONIC HEART FAILURE IN PRIMARY CARE: WHAT EVIDENCE DO WE HAVE FOR HEART FAILURE WITH PRESERVED SYSTOLIC FUNCTION?

    Directory of Open Access Journals (Sweden)

    PITERMAN L

    2010-01-01

    Full Text Available Chronic Heart Failure (CHF is a debilitating illness commonly encountered in primary care. Its prevalence in developing countries is rising as a result of an ageing population, and an escalating epidemic of hypertension, type 2 diabetes and coronary heart disease. CHF can be specifically diagnosed as Heart Failure with Reduced Systolic Function (HF-RSF or Heart Failure with Preserved Systolic Function (HF-PSF. This paper illustrates a common presentation of HF-PSF in primary care; and critically appraises the evidence in support of its diagnosis, prognosis and management. Regardless of the specific diagnosis, long term management of CHF is intricate as it involves a complex interplay between medical, psychosocial, and behavioural factors. Hence, there is a pressing need for a multidisciplinary team management of CHF in primary care, and this usually takes place within the broader context of an integrated chronic disease management programme. Primary care physicians are ideally suited to lead multidisciplinary teams to ensure better co-ordination, continuity and quality of care is delivered for patients with chronic conditions across time and settings. Given the rising epidemic of cardiovascular risk factors in the Malaysian population, preventive strategies at the primary care level are likely to offer the greatest promise for reducing the growing burden of CHF.

  17. Heart Failure Virtual Consultation: bridging the gap of heart failure care in the community - A mixed-methods evaluation.

    Science.gov (United States)

    Gallagher, Joseph; James, Stephanie; Keane, Ciara; Fitzgerald, Annie; Travers, Bronagh; Quigley, Etain; Hecht, Christina; Zhou, Shuaiwei; Watson, Chris; Ledwidge, Mark; McDonald, Kenneth

    2017-08-01

    We undertook a mixed-methods evaluation of a Web-based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs. All cases from June 2015 to October 2016 were recorded using a standardized recording template, which recorded patient demographics, medical history, medications, and outcome of the virtual consult for each case. Quantitative surveys and qualitative interviewing of 17 participating GPs were also undertaken. During this time, 142 cases were discussed-68 relating to a new diagnosis of heart failure, 53 relating to emerging deterioration in a known heart failure patient, and 21 relating to therapeutic issues. Only 17% required review in outpatient department following the virtual consultation. GPs reported increased confidence in heart failure management, a broadening of their knowledge base, and a perception of overall better patient outcomes. These data from an initial experience with Heart Failure Virtual Consultation present a very positive impact of this strategy on the provision of heart failure care in the community and acceptability to users. Further research on the implementation and expansion of this strategy is warranted. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

  18. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population.

    Science.gov (United States)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R

    2007-10-01

    This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in the United Kingdom. The European Heart Failure Self-care Behaviour Scale quantifies the measures patients take to manage their heart failure. Produced in the Netherlands and Sweden, it has been translated into English. A convenience sample of 183 patients (response rate 85%) with heart failure (New York Heart Association, Class I-IV) was recruited from an outpatient clinic between July 2004 and July 2005. Mainly men (n = 143), they had a mean age of 65.6 years (sd = 12.3). They completed the Minnesota Living with Heart Failure Questionnaire, the Self-Care of Heart Failure Index, and the European Heart Failure Self-care Behaviour Scale during their clinic visit. The latter questionnaire was repeated at home within 2 weeks. The scale was reliable but internal consistency was only moderate (Cronbach's alpha = 0.69) and lower than in other European populations. It appears to be repeatable in the short-term. Comparison with the Self-Care of Heart Failure Index raised questions about whether the two questionnaires measured the same concept. Variance in self-care was not explained by gender, age or severity of heart failure. As self-care is an important component in the life of patients with heart failure, further exploration of the methods for measuring patients' self-care behaviours is warranted to enable healthcare staff to assess patients effectively. This would also help in understanding the applicability of tools in a range of patients, cultures and settings.

  19. Self-Care Behaviors among Patients with Heart Failure in Iran

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2012-11-01

    Full Text Available Introduction: Recovery from heart failure and dealing with its effects is significantly influenced by patient’s self-care. In order to maximize the effects of behavioral interventions and for educational planning, it is essential to know how much experience and information do patients with heart failure have about their disease and self-care behaviors. The present study aimed to identify self-care behaviors in patients with heart failure. Methods: Eighty heart failure patients hospitalized in Shahid Madani Training Center in Tabriz, Iran, participated in this study. Data collection was done through Self-Care of Heart Failure Index (SCHFI that contained 22 questions in three sections including self-care behaviors, self-care management and confidence in performing self-care behaviors. Results: The patient’s self-care behaviors in three behavioral sub categories of maintaining, managing and confidence were low. The most repeated self-care behavior in the participating patients was taking medication and visiting the doctor. Conclusion: The results of the study showed low levels of self-care behaviors in patients with heart failure, which notes the need for patient empowerment. It is necessary to develop appropriate strategies in this regard by the authorities

  20. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    Science.gov (United States)

    Willemse, Evi; Adriaenssens, Jef; Dilles, Tinne; Remmen, Roy

    2014-07-01

    This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner. The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation. This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model. The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse. Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

  1. The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting.

    Science.gov (United States)

    Busari, Jamiu O; Duits, Ashley J

    2015-01-21

    Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system. Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training. In order to achieve a VBHC system in a resource-limited environment, the standard of physicians' competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.

  2. Improving the quality of transition and transfer of care in young adults with congenital heart disease.

    Science.gov (United States)

    Everitt, Ian K; Gerardin, Jennifer F; Rodriguez, Fred H; Book, Wendy M

    2017-05-01

    The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease-specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients. © 2017 Wiley Periodicals, Inc.

  3. Perceived social support and self-care in patients hospitalized with heart failure.

    Science.gov (United States)

    Chamberlain, Lyne

    2017-12-01

    Rehospitalization of heart failure patients is often considered the result of inadequate self-care yet only one study documents superior outcomes with better self-care. If inadequate self-care is related to hospitalizations, then hospitalized heart failure patients should have lower self-care skills than non-hospitalized patients. The purpose of this study was to evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure. The self-care of heart failure index (SCHFI) and medical outcomes study of social support (MOS-SS) were the key instruments used in the research. This descriptive study used t tests and multiple regression to analyze the data. Results were compared with non-hospitalized heart failure patients in another study. Perceived social support ( t=-4.007, df=211, P<0.001) and self-care maintenance ( t=-3.343, df=220, P<0.002) scores were lower in the hospitalized participants than the comparison group. Self-care confidence was the only variable significantly related to perceived social support ( β=0.210, t=2.210, P<0.30). This study supports the premise that heart failure rehospitalizations are related to inadequate self-care.

  4. The comparative palliative care needs of those with heart failure and cancer patients.

    Science.gov (United States)

    O'Leary, Norma

    2009-12-01

    Patients with heart failure seem particularly suited to palliative care having needs that fall within the prototypical palliative care domains. Despite this there is still much debate as to who should respond to these needs and when. Since the early 1990s many studies have been published outlining the unmet needs of patients with heart failure. However, there have been limitations to these studies and they have not guided professionals as to how to respond. More recently comparative studies using cancer as the reference have explored similarities and highlighted differences in need between heart failure and cancer patients. These studies are useful for informing future service development. Patients with heart failure have variable needs and variable disease trajectories. A targeted response to these needs is required. Palliative triggers or transitions should be recognized by professionals caring for patients with heart failure. It is unlikely that either specialist palliative care or medical specialists working in isolation will be sufficiently experienced to respond to these needs. Research is required to determine the effectiveness of different collaborative approaches; heart failure specialist care aligned with palliative care consultancy or heart failure-oriented palliative care services.

  5. The comparative palliative care needs of those with heart failure and cancer patients.

    LENUS (Irish Health Repository)

    O'Leary, Norma

    2012-02-01

    PURPOSE OF REVIEW: Patients with heart failure seem particularly suited to palliative care having needs that fall within the prototypical palliative care domains. Despite this there is still much debate as to who should respond to these needs and when. RECENT FINDINGS: Since the early 1990s many studies have been published outlining the unmet needs of patients with heart failure. However, there have been limitations to these studies and they have not guided professionals as to how to respond. More recently comparative studies using cancer as the reference have explored similarities and highlighted differences in need between heart failure and cancer patients. These studies are useful for informing future service development. SUMMARY: Patients with heart failure have variable needs and variable disease trajectories. A targeted response to these needs is required. Palliative triggers or transitions should be recognized by professionals caring for patients with heart failure. It is unlikely that either specialist palliative care or medical specialists working in isolation will be sufficiently experienced to respond to these needs. Research is required to determine the effectiveness of different collaborative approaches; heart failure specialist care aligned with palliative care consultancy or heart failure-oriented palliative care services.

  6. A situation-specific theory of heart failure self-care.

    Science.gov (United States)

    Riegel, Barbara; Dickson, Victoria Vaughan

    2008-01-01

    Heart failure, a common syndrome in developed countries worldwide, is associated with poor quality of life, frequent rehospitalizations, and early death. Self-care is essential to improving outcomes in this patient population. The purpose of this article is to describe a situation-specific theory of heart failure self-care in which self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Self-care maintenance is further defined to encompass routine symptom monitoring and treatment adherence. Self-care management is characterized as a process initiated by symptom recognition and evaluation, which stimulates the use of self-care treatments and treatment evaluation. Confidence in self-care is thought to moderate and/or mediate the effect of self-care on various outcomes. Four propositions were derived from the self-care of heart failure conceptual model: (1) symptom recognition is the key to successful self-care management; (2) self-care is better in patients with more knowledge, skill, experience, and compatible values; (3) confidence moderates the relationship between self-care and outcomes; and (4) confidence mediates the relationship between self-care and outcomes. These propositions were tested and supported using data obtained in previous research. Support of these propositions provides early evidence for this situation-specific theory of heart failure self-care.

  7. Managing heart failure in primary care: first steps in implementing the National Service Framework.

    Science.gov (United States)

    Gnani, Shamini; Gray, Jeremy; Khunti, Kamlesh; Majeed, Azeem

    2004-03-01

    Heart failure is common, causes considerable morbidity, and imposes a major financial burden on both society and the National Health Service. The National Service Framework (NSF) for Coronary Heart Disease (CHD) set national standards for the management of people with heart failure in England. We examined how patients with heart failure were investigated and treated compared with NSF standards, and explored the current constraints in improving the care of these patients. This study was carried out in two general practices (total list size 19,600) in south London. Using a computer search strategy, patients with possible heart failure were identified and clinical data extracted from their medical records. Workshops on heart failure were held at a national conference on disease management in primary care, and key stakeholders were interviewed to identify constraints in improving management. Ninety patients with heart failure were identified through the computerized search. Seventy-eight patients (87 per cent) had a Read code for heart failure on their electronic medical record. Forty-eight (53 per cent) patients were men and 10 (12 per cent) were aged less than 65 years. Forty-nine per cent of patients had undergone an electrocardiogram and 42 per cent an echocardiogram. Angiotensin-converting enzyme (ACE) inhibitors were prescribed to 54 per cent of patients. In the workshops and stakeholder interviews, healthcare professionals and managers reported difficulties in implementing the NSF. They expressed concerns regarding the difficulties in confirming a diagnosis of heart failure, including access to echocardiograms, prescribing ACE inhibitors among older patients, and the additional workload and resources needed to ensure they met the NSF standards for heart failure. The accurate identification of heart failure patients and recording of clinical information as part of disease registers needs to improve if primary care teams are to meet the NSF standards. There is

  8. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

    Science.gov (United States)

    Feld, April; Madden-Baer, Rose; McCorkle, Ruth

    2016-01-01

    The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

  9. Trends in quality of care among patients with incident heart failure in Denmark 2003-2010

    DEFF Research Database (Denmark)

    Nakano, Anne; Johnsen, Søren Paaske; Frederiksen, Birgitte Lidegaard

    2013-01-01

    The treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care...... and clinical outcome of HF patients using indicator monitoring combined with systematic auditing....

  10. Patient Education Leads to Better Care for Heart Patients.

    Science.gov (United States)

    Rosenberg, Stanley G.

    The staff of a heart and circulatory disease program of a State department of health conducted a special project at a city hospital which showed that a well-organized treatment and education program for patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a…

  11. Organization-and-technological model of medical care delivered to patients with coronary heart disease

    Directory of Open Access Journals (Sweden)

    Popova Y.V.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with coronary heart disease based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  12. Organization-and-technological model of medical care delivered to patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Kiselev A.R.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with chronic heart failure based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  13. Integrated, collaborative palliative care in heart failure: the St. George Heart Failure Service experience 1999-2002.

    Science.gov (United States)

    Davidson, Patricia M; Paull, Glenn; Introna, Kate; Cockburn, Jill; Davis, Jan Maree; Rees, David; Gorman, David; Magann, Linda; Lafferty, Mary; Dracup, Kathleen

    2004-01-01

    Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues. To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program. A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002. Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting. In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.

  14. Availability of Heart Failure Medications in Hospice Care.

    Science.gov (United States)

    Lum, Hillary D; Horney, Carolyn; Koets, David; Kutner, Jean S; Matlock, Daniel D

    2016-12-01

    Availability of cardiac medications in hospice for acute symptom management of heart failure is unknown. This study explored hospice approaches to cardiac medications for patients with heart failure. Descriptive study using a quantitative survey of 46 US hospice agencies and clinician interviews. Of 31 hospices that provided standard home medication kits for acute symptom management, only 1 provided medication with cardiac indications (oral furosemide). Only 22% of the hospice agencies had a specific cardiac medication kit. Just over half (57%) of the agencies could provide intravenous inotropic therapy, often in multiple hospice settings. Clinicians described an individualized approach to cardiac medications for patients with heart failure. This study highlights opportunities for practice guidelines that inform medical therapy for hospice patients with heart failure. © The Author(s) 2015.

  15. Frailty syndrome and self-care ability in elderly patients with heart failure

    Science.gov (United States)

    Uchmanowicz, Izabella; Wleklik, Marta; Gobbens, Robbert JJ

    2015-01-01

    Background Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty. Methods The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale. Results Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social). Conclusion The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty. PMID:26028966

  16. Development and testing of the European Heart Failure Self-Care Behaviour Scale.

    Science.gov (United States)

    Jaarsma, T; Strömberg, A; Mårtensson, J; Dracup, K

    2003-06-01

    Improvement of self-care behaviour is an aim of several non-pharmacological nurse-led management programmes for patients with heart failure. These programmes are often evaluated based on their effects on readmission, costs and quality of life. It is, however, also important to know how patients changed their self-care behaviour as a result of such a programme. Therefore a comprehensive, reliable and valid measure of the self-care behaviour of HF patients is needed. To develop a scale measuring the behaviour that heart failure patients perform to maintain life, healthy functioning, and well-being. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed in three phases: (1) concept analysis and first construction; (2) revision of items and response and scoring format; and (3) testing of the new scale for validity and reliability. The European Heart Failure Self-Care Behaviour Scale is a 12-item, self-administered questionnaire that covers items concerning self-care behaviour of patients with heart failure. Face-validity and concurrent validity was established and the internal consistency of the scale was tested using pooled data of 442 patients from two centres in Sweden, three in the Netherlands and one in Italy. Cronbachs's alpha was 0.81. The instrument is a valid, reliable and practical scale to measure the self-reported self-care behaviour of heart failure patients. It is ready to use by investigators evaluating the outcome of heart failure management programmes that target changes in patients' self-care practices.

  17. Beyond social support: Self-care confidence is key for adherence in patients with heart failure.

    Science.gov (United States)

    Hammash, Muna H; Crawford, Timothy; Shawler, Celeste; Schrader, Melanie; Lin, Chin-Yen; Shewekah, Deena; Moser, Debra K

    2017-10-01

    Adherence to treatment is crucial to improve outcomes in patients with heart failure. Good social support is associated with better adherence, but the mechanism for this association has not been well-explored. The aim of this secondary analysis was to examine whether self-care confidence mediates the relationship between social support and treatment adherence in heart failure patients hospitalized with acute exacerbation. A total of 157 inpatients with heart failure (63.5±13 years, 73% New York Heart Association class III/IV) were recruited from two hospitals located in urban areas in the USA. Participants completed the Self-Care of Heart Failure Index, the Multidimensional Perceived Social Support Scale, and the Medical Outcomes Study Specific Adherence Scale. A series of regression models were used to determine the mediation relationship. Controlling for marital status and hospital site, social support was associated with adherence ( p=0.03). When self-confidence was included in the model, the effect of social support became non-significant, indicating full mediation of the relationship between social support and adherence by self-care confidence. The indirect effect (0.04) of social support on adherence through self-confidence was significant (95% confidence interval: 0.01-0.09). Heart failure self-care confidence mediated the relationship between social support and treatment adherence. Thus interventions targeting patients' self-care confidence is essential to maximize patients' treatment adherence.

  18. A disease management program for heart failure: collaboration between a home care agency and a care management organization.

    Science.gov (United States)

    Gorski, Lisa A; Johnson, Kathy

    2003-01-01

    This article describes a collaborative approach to manage patients with heart failure between a home care agency and a care management agency. The resulting disease management program used a combination of home visits and phone contact. Care management plans emphasized patient education on increasing adherence to medical and diet regimens, and recognizing early symptoms of exacerbation that could lead to rehospitalization. Clinician activities and patient outcomes are described.

  19. Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure

    OpenAIRE

    Hua, C.Y.; Huang, Y.; Su, Y.H.; Bu, J.Y.; Tao, H.M.

    2017-01-01

    Chronic heart failure (CHF) is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM) on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of...

  20. Structural equation model testing the situation-specific theory of heart failure self-care.

    Science.gov (United States)

    Vellone, Ercole; Riegel, Barbara; D'Agostino, Fabio; Fida, Roberta; Rocco, Gennaro; Cocchieri, Antonello; Alvaro, Rosaria

    2013-11-01

    To test the situation-specific theory of heart failure self-care with structural equation modelling. Several authors have proposed theories on heart failure self-care, but only the situation-specific theory of heart failure self-care by Riegel and Dickson is focused on the process that patients use to perform self-care. This theory has never been tested with structural equation modelling. A secondary analysis of data from a cross-sectional study. Patients with heart failure were recruited in 21 cardiovascular centres across Italy during 2011. Data were collected with a sociodemographic questionnaire, chart abstraction for clinical data and the Self-Care of Heart Failure Index v.6.2. A sample of 417 participants was enrolled in the study (59% males, mean age 72 years). The following propositions were tested and supported: Symptom monitoring correlates with treatment adherence; symptom monitoring and treatment adherence have a direct, positive relationship with symptom recognition and evaluation that in turn have a direct, positive relationship with treatment implementation; treatment implementation has a direct, positive relationship with treatment evaluation. In addition, the following three relationships were found: Symptom monitoring has a direct, positive relationship with treatment implementation; symptom recognition and evaluation have direct, positive relationships with treatment evaluation and symptom monitoring correlates with treatment evaluation. [Correction added on 9th April 2013, after first online publication: '…symptom monitoring correlates with treatment implementation.' has been corrected to read '…symptom monitoring correlates with treatment evaluation.'] The data support the situation-specific theory of heart failure self-care with the addition of three new relationships that emerged from the analysis. Results of this study lend further support to the use of the situation-specific theory of heart failure self-care in research and practice.

  1. Palliative care in heart failure : A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Zhou, K; Mao, Y

    2018-02-21

    Palliative care can play an important role in the management of heart failure. We conducted a systematic review and meta-analysis to compare the efficacy and safety of palliative care in patients with heart failure. PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) on the impact of palliative care on heart failure were included. Two investigators independently searched the articles, extracted data, and assessed the quality of included studies. The primary outcome was mortality. Seven RCTs were included in the meta-analysis. Compared with usual care for heart failure, palliative care was associated with a significantly increased quality of life (standardized mean difference = 1.46; 95% confidence interval [CI] = 0.12 to 2.79; p = 0.03) and reduced depression scores (standardized mean difference = -0.62; 95% CI = -0.99 to -0.25; p = 0.03), but demonstrated no impact on mortality (risk ratio [RR] = 1.28; 95% CI = 0.86 to 1.92; p = 0.22) and rehospitalization (RR = 0.84; 95% CI = 0.66 to 1.07; p = 0.16). Palliative care can improve the quality of life and reduce the occurrence of depression in patients with heart failure.

  2. Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure.

    Science.gov (United States)

    Hua, C Y; Huang, Y; Su, Y H; Bu, J Y; Tao, H M

    2017-09-21

    Chronic heart failure (CHF) is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM) on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of heart failure index and short form health survey 12, respectively. Further, cardiac function was assessed by measuring left ventricular ejection fraction (LVEF) and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), and by the 6-min walking test. Clinical and demographic characteristics of patients in the control and CCM groups were statistically equivalent. Compared with usual care, CCM significantly enhanced self-care abilities of patients with CHF, including self-care maintenance, self-care management and self-care confidence (all Pself-care, quality of life and cardiac function of patients with CHF compared with usual care.

  3. How Do Cognitive Function and Knowledge Affect Heart Failure Self-Care?

    Science.gov (United States)

    Dickson, Victoria Vaughan; Lee, Christopher S.; Riegel, Barbara

    2011-01-01

    Despite extensive patient education, few heart failure (HF) patients master self-care. Impaired cognitive function may explain why patient education is ineffective. A concurrent triangulation mixed methods design was used to explore how knowledge and cognitive function influence HF self-care. A total of 41 adults with HF participated in interviews…

  4. Building mobile technologies to improve transitions of care in adolescents with congenital heart disease

    Science.gov (United States)

    Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to roughly 1.4 million survivors reaching adulthood. This emerging "survivor" population are often palliated but not cured. Thus successful transition from pediatric to adult care for CHD pa...

  5. Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

    Directory of Open Access Journals (Sweden)

    Stefan Köberich

    2015-07-01

    Full Text Available Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

  6. Palliative care for patients with heart failure: description of a service.

    Science.gov (United States)

    Johnson, M J; Houghton, T

    2006-04-01

    Over the past 10 years, there has been an increasing demand for heart failure patients to have access to palliative care services. The concerns of this group have been highlighted and there is growing recognition in national palliative care and cardiology bodies that these concerns should be addressed. In spite of this, there is little improvement. There are concerns about the acceptability of hospice services to heart failure patients, worries about service overload, lack of appropriate knowledge and skills and difficulty in knowing when to refer a heart failure patient for palliative care. In Scarborough, a joint approach by a cardiologist and palliative care physician was set up in September 2000. This paper describes the service so far in an attempt to address some of the above reservations and to provide a catalyst and encouragement to others beginning a similar venture.

  7. Mothers and Fathers Experience Stress of Congenital Heart Disease Differently: Recommendations for Pediatric Critical Care.

    Science.gov (United States)

    Sood, Erica; Karpyn, Allison; Demianczyk, Abigail C; Ryan, Jennie; Delaplane, Emily A; Neely, Trent; Frazier, Aisha H; Kazak, Anne E

    2018-03-10

    To inform pediatric critical care practice by examining how mothers and fathers experience the stress of caring for a young child with congenital heart disease and use hospital and community supports. Qualitative study of mothers and fathers of young children with congenital heart disease. Tertiary care pediatric hospital in the Mid-Atlantic region of the United States. Thirty-four parents (20 mothers, 14 fathers) from diverse backgrounds whose child previously underwent cardiac surgery during infancy. Subjects participated in semi-structured, individual interviews about their experiences and psychosocial needs at the time of congenital heart disease diagnosis, surgical admission, and discharge to home after surgery. Qualitative interview data were coded, and consistent themes related to emotional states, stressors, and supports were identified. Fathers experience and respond to the stressors and demands of congenital heart disease in unique ways. Fathers often described stress from not being able to protect their child from congenital heart disease and the associated surgeries/pain and from difficulties balancing employment with support for their partner and care of their congenital heart disease child in the hospital. Fathers were more likely than mothers to discuss support from the work environment (coworkers/managers, flexible scheduling, helpful distraction) and were less likely to describe the use of hospital-based resources or congenital heart disease peer-to-peer supports. This study highlights the importance of understanding the paternal experience and tailoring interventions to the unique needs of both mothers and fathers. Opportunities for critical care practice change to promote the mental health of mothers and fathers following a diagnosis of congenital heart disease are discussed.

  8. Update on ischemic heart disease and critical care cardiology.

    Science.gov (United States)

    Marín, Francisco; Díaz-Castro, Oscar; Ruiz-Nodar, Juan Miguel; García de la Villa, Bernardo; Sionis, Alessandro; López, Javier; Fernández-Ortiz, Antonio; Martínez-Sellés, Manuel

    2014-02-01

    This article summarizes the main developments reported in 2013 on ischemic heart disease, together with the most important innovations in the management of acute cardiac patients. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  9. [Health literacy in patients with heart failure treated in primary care].

    Science.gov (United States)

    Santesmases-Masana, Rosalia; González-de Paz, Luis; Real, Jordi; Borràs-Santos, Alicia; Sisó-Almirall, Antoni; Navarro-Rubio, Maria Dolors

    2017-01-01

    The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. A multicentre cross-sectional study. 10 Primary care centres from the metropolitan area of Barcelona. Patients diagnosed with heart failure. to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  10. Unique Correlates of Heart Failure and Cancer Caregiver Satisfaction With Hospice Care.

    Science.gov (United States)

    MacKenzie, Meredith A; Buck, Harleah G; Meghani, Salimah H; Riegel, Barbara

    2016-01-01

    Heart failure patients, along with their informal caregivers are increasingly enrolling in hospice care. Caregiver satisfaction with hospice care is a key quality indicator. The role that diagnosis plays in shaping satisfaction is unclear. Our aim was to identify unique correlates of caregiver satisfaction in heart failure and cancer caregivers and explore whether the identified correlates differ between the two diagnosis groups. This was a retrospective cohort study of national data collected in 2011 by the National Hospice and Palliative Care Organization using the 61-item Family Evaluation of Hospice Care survey. We used complete Family Evaluation of Hospice Care responses of adult heart failure (n = 7324) and cancer (n = 23,871) caregivers. Multiple logistic regression was used to examine the relationship between possible correlates and caregiver satisfaction. Correlates examined included caregiver and patient demographics, patient clinical characteristics, and hospice characteristics. Caregiver-reported patient dyspnea was associated with global and symptom management satisfaction in the heart failure cohort, whereas caregiver race was associated with global and symptom management satisfaction in the cancer cohort. Nursing home placement was associated with lower satisfaction odds in both cancer and heart failure cohorts, but heart failure patients were twice as likely as cancer patients to receive care in a nursing home. This study generated hypotheses about unique factors related to caregiver satisfaction among two diagnosis cohorts that require further study, particularly the impact of race on satisfaction in the cancer cohort and the management of dyspnea in heart failure hospice patients. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  11. Transition of care in congenital heart disease from pediatrics to adulthood.

    Science.gov (United States)

    Said, Sameh M; Driscoll, David J; Dearani, Joseph A

    2015-04-01

    Improvement in surgical techniques, anesthesia, and perioperative care has resulted in the majority of children born with congenital heart defects surviving into adulthood with a normal or near-normal quality of life. A careful transition from pediatric to adult care providers is important to avoid issues related to loss of continuity of care and any undue financial or psychological burdens to the patients and their families. The patients, their families, and the health care providers are faced with many challenges during this transition process that can be optimized and overcome by education about the heart defects and a team approach with clear lines of communication. This review addresses the challenges related to the transition of care from pediatrics to adults and provides the necessary recommendations to ensure a smooth transition process. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Heart failure patients' experiences with continuity of care and its relation to medication adherence: a cross-sectional study

    NARCIS (Netherlands)

    Uijen, A.A.; Bosch, M.; Bosch, W.J. van den; Bor, H.; Wensing, M.J.P.; Schers, H.J.

    2012-01-01

    ABSTRACT: BACKGROUND: A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients' experiences with

  13. Hospital experiences of young adults with congenital heart disease: divergence in expectations and dissonance in care.

    Science.gov (United States)

    Kools, Susan; Tong, Elizabeth M; Hughes, Rene; Jayne, Rae; Scheibly, Kimberly; Laughlin, Judith; Gilliss, Catherine L

    2002-03-01

    Despite increasing survival for adults with congenital heart disease, little is known about hospitalization for young adult patients with this disease and for their families. Because of the complexity of the disease and its management during the life span, young adults are often hospitalized on both pediatric and adult units during a stay in the hospital. To explore the experience of hospitalization of young adults with congenital heart disease, the experience of their families, and the views of the nurses who cared for these patients and to generate substantive theory on interactions between patients, patients' families, and nurses. Semistructured interviews and naturalistic observations were conducted with young adults with congenital heart disease (mean age, 28.6 years), their family members, and nurses who cared for the patients during hospitalization (N=34). Dimensional analysis was used to analyze interviews and field notes from observations. A grounded theory was derived, explaining how the hospital context and relationships between patients, patients' families, and nurses affect patients' hospital experiences. Expectations differed among the groups, leading to dissonance in care, as exemplified by role confusion and power struggles over control of care. This dissonance resulted in interpersonal conflict, distrust, anxiety, and dissatisfaction with the care and caring experiences. Changes in hospital units, a better understanding of the healthcare needs of young adults with congenital heart disease, and acknowledgment of the expertise of patients and patients' families are needed to improve nursing care for these patients and their families.

  14. Development of the Heart Failure Screening Tool (Heart-FaST) to measure barriers that impede engagement in self-care.

    Science.gov (United States)

    Cameron, Jan; Ski, Chantal F; McLennan, Skye N; Rendell, Peter G; Whitbourn, Robert J; Thompson, David R

    2014-10-01

    Screening for self-care capacity is advocated before applying educational strategies. No screening tool has been specifically developed to assess barriers that impede engagement in self-care in people with heart failure. Earlier conceptual work (InCOGNITO) identified NYHA class, mild cognitive impairment and depressive symptoms as barriers that impede engagement in HF self-care. Study aims were: 1) to develop the Heart Failure Screening Tool (Heart-FaST) as a means of assessing three critical barriers to self-care; 2) to assess the content validity of the Heart-FaST; and 3) to test the feasibility of implementing the Heart-FaST in clinical practice. The Heart-FaST was developed from barriers identified in previous research (InCOGNITO) and from expert panel consensus. Content validity was assessed by examining the proportion of experts who scored each item as relevant. The InCOGNITO study indicated that four cognitive tasks, seven emotional questions and NYHA functional class were significantly correlated with the self-care scales: maintenance, management and confidence. These factors were used to create the Heart-FaST items. Consensus on wording and items to be included in the Heart-FaST was reached after two rounds of panel discussion. All items had an item-level content validity index ≥ 0.78. High scores on each barrier (physical, cognitive and emotional functioning) suggest poor self-care and the need for more intensive disease management efforts. The Heart-FaST measures three critical barriers that impede engagement in self-care. In clinical practice this tool may assist in individually tailoring educational and support strategies to promote effective heart failure self-care. © The European Society of Cardiology 2013.

  15. [Organizational and medical aspects of transition of juveniles with congenital heart defects to adult cardiology care].

    Science.gov (United States)

    Oechslin, E; Hoffmann, A

    2001-02-01

    A growing, heterogeneous group of children with congenital heart disease is surviving into adulthood due to advances in medicine. These patients including those with simple and complex congenital heart disease and operated on during childhood are facing long-term complications. Superspecialist care and expertise are required during their life to deal with their unique problems the most common being ventricular failure, arrhythmias, valve and conduit longevity. Teenagers and adolescents disappear from both medical and parental care because of the lack of transition programs. Transition of care from pediatric to adult cardiologists must be organized in each country and must reflect regional history, regional politics and realities. Transition of care requires goodwill from parents, adolescents, pediatric and adult cardiologists. Transition clinics being held jointly by pediatric and adult cardiologists between the age of 16 and 18 years are essential to encourage the adolescents to take charge of their own life and health issues. Adequate information about their heart defect, their operations and their residual lesions may help them understand the implications for the future and improve their compliance. A transition program must include counseling on education, career, endocarditis prophylaxis, insurance and lifestyle issues such as sexuality and reproduction (including anticonception, pregnancy), cardiovascular risk factors and sports activities. Medical reports including operative reports and heart catheterization reports must be transferred to the adult cardiologists. In Switzerland, care of adults with congenital heart disease is based on three levels: 1) primary caregivers including general practiioners, internists and community cardiologists; 2) cardiologists with special commitment and expertise to patients with congenital heart disease who organize regional outpatient clinics; 3) supraregional referral centers with cardiologists trained in pediatric and

  16. Ultrasound for critical care physicians: now my heart is full

    Directory of Open Access Journals (Sweden)

    Bhatia S

    2014-11-01

    Full Text Available No abstract available. Article truncated after the first page. A 65 year old woman with a history of hypertension and a recent diagnosis of multiple myeloma was admitted to the ICU with septic shock due to Morganella morganii bacteremia. She was treated with cefepime, levophed and dobutamine. During treatment she developed symptoms and a chest x-ray compatible with congestive heart failure. A transthoracic echo is shown below (Figures 1 and 2. Additionally a spectral pulsed-wave Doppler study of the mitral inflow velocities is presented (Figure 3. What is the best explanation for the findings seen in on the echocardiogram? 1. Cardiac amyloidosis; 2. Hypertensive heart disease; 3. Hypertrophic cardiomyopathy; 4. Stress (Takotsubo cardiomyopathy.

  17. Health care providers and human trafficking: what do they know, what do they need to know? Findings from the Middle East, the Caribbean and Central America.

    Directory of Open Access Journals (Sweden)

    Roderik F Viergever

    2015-01-01

    Full Text Available BackgroundHuman trafficking is a crime that commonly results in acute and chronic physical and psychological harm. To foster more informed health sector responses to human trafficking, training sessions for health care providers were developed and pilot-tested in the Middle East, Central America and the Caribbean. This study presents the results of an investigation into what health care providers knew and needed to know about human trafficking as part of that training program.MethodsParticipants attended one of seven two-day training courses in Antigua and Barbuda, Belize, Costa Rica, Egypt, El Salvador, Guyana and Jordan. We assessed participants’ knowledge about human trafficking and opinions about appropriate responses in trafficking cases via questionnaires pre-training, and considered participant feedback about the training post-training. Results178 participants attended the trainings. Pre-training questionnaires were completed by 165 participants (93% and post-training questionnaires by 156 participants (88%. Pre-training knowledge about health and human trafficking appeared generally high for topics such as the international nature of trafficking and the likelihood of poor mental health outcomes among survivors. However, many participants had misconceptions about the characteristics of trafficked persons and a provider’s role in responding to cases of trafficking. The most valued training components included the Role of the Health Provider, Basic Definitions and Concepts and Health Consequences of Trafficking. DiscussionTraining health care providers on caring for trafficked persons has the potential to improve practitioners’ knowledge about human trafficking and its health consequences, and to increase safe practices when responding in cases of trafficking. This study provides lessons for the design of training programs on human trafficking that aim to help health care providers identify and refer victims, and provide care for

  18. Health care providers and human trafficking: what do they know, what do they need to know? Findings from the middle East, the Caribbean, and central america.

    Science.gov (United States)

    Viergever, Roderik F; West, Haley; Borland, Rosilyne; Zimmerman, Cathy

    2015-01-01

    Human trafficking is a crime that commonly results in acute and chronic physical and psychological harm. To foster more informed health sector responses to human trafficking, training sessions for health care providers were developed and pilot-tested in the Middle East, Central America, and the Caribbean. This study presents the results of an investigation into what health care providers knew and needed to know about human trafficking as part of that training program. Participants attended one of seven two-day training courses in Antigua and Barbuda, Belize, Costa Rica, Egypt, El Salvador, Guyana, and Jordan. We assessed participants' knowledge about human trafficking and opinions about appropriate responses in trafficking cases via questionnaires pre-training, and considered participant feedback about the training post-training. 178 participants attended the trainings. Pre-training questionnaires were completed by 165 participants (93%) and post-training questionnaires by 156 participants (88%). Pre-training knowledge about health and human trafficking appeared generally high for topics such as the international nature of trafficking and the likelihood of poor mental health outcomes among survivors. However, many participants had misconceptions about the characteristics of trafficked persons and a provider's role in responding to cases of trafficking. The most valued training components included the "Role of the Health Provider," "Basic Definitions and Concepts," and "Health Consequences of Trafficking." Training health care providers on caring for trafficked persons has the potential to improve practitioners' knowledge about human trafficking and its health consequences, and to increase safe practices when responding in cases of trafficking. This study provides lessons for the design of training programs on human trafficking that aim to help health care providers identify and refer victims, and provide care for survivors.

  19. AN ANALYSIS OF VALVULAR HEART DISEASE BY ECHOCARDIOGRAPHY- A TERTIARY CARE INSTITUTE STUDY

    Directory of Open Access Journals (Sweden)

    Perumal Jaisankar

    2017-06-01

    Full Text Available BACKGROUND Diseases of heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide. In developing countries, Rheumatic Heart Disease (RHD continues to be the predominant form of valvular heart disease. The current study was undertaken at a Tertiary Care Institute with an objective of establishing distribution and different patterns of valvular heart diseases by echocardiography. MATERIALS AND METHODS 17,625 consecutive first time Echocardiograms performed between January 2016 and December 2016 were analysed. Echo was performed by consultant cardiologists using Philips HD11XE and Aloka SSD4000 machine following ASE guidelines. Applying exclusion criteria of trivial and functional regurgitant lesions yielded a total of 632 cases of organic valvular heart diseases. RESULTS In our study 632 patients were diagnosed with valvular heart disease, out of which 428 patients (67.7% were diagnosed with Rheumatic Heart Disease. Mitral valve was the most commonly affected followed by aortic and tricuspid valves. The least commonly affected valve was pulmonary valve. In Rheumatic heart disease, most common isolated lesion reported was MS with MR, most commonly reported in females between 21 - 40 years’ age group. CONCLUSION In non-RHD group, mitral valve prolapse (21.3% was the commonest lesion reported followed by calcific degenerative aortic valve (6.17% and congenital bicuspid aortic valve (3.4%; 118 patients were reported with multivalvular lesion. MS + MR + AR was the commonest multivalvular lesion found in 65 patients (55.08%.

  20. ?Who is on your health?care team?? Asking individuals with heart failure about care team membership and roles

    OpenAIRE

    LaDonna, Kori A.; Bates, Joanna; Tait, Glendon R.; McDougall, Allan; Schulz, Valerie; Lingard, Lorelei; Burge, F.; Burnett, S.; Harkness, K.; Marshall, D.; McKelvie, R.; Strachan, P.; Lowery, D.; Ward, D.; Smith, S.

    2016-01-01

    Abstract Background Complex, chronically ill patients require interprofessional teams to address their multiple health needs; heart failure (HF) is an iconic example of this growing problem. While patients are the common denominator in interprofessional care teams, patients have not explicitly informed our understanding of team composition and function. Their perspectives are crucial for improving quality, patient?centred care. Objectives To explore how individuals with HF conceptualize their...

  1. [Role of outpatient heart failure clinics and primary care physicians in the tailored follow-up of heart failure patients].

    Science.gov (United States)

    De Maria, Renata; Misuraca, Gianfranco; Milli, Massimo; Filippi, Alessandro

    2010-05-01

    Continuity of care is pivotal to appropriately manage patients affected by heart failure (HF). HF is a chronic disease with frequent exacerbations that requires long-term care at different complexity levels. The lack of adequate communication between hospital cardiologists and primary care physicians (PCPs) is the main pitfall in continuity of care for HF patients. To overcome this problem, all dedicated outpatient HF clinics should organize together with PCPs in the community educational and auditing initiatives, based on locally derived performance measures to assess the appropriateness and effectiveness of integrated care pathways. The primary task of PCPs is to follow up stable HF patients and focus assessment on patient empowerment, adjustment of drug therapy, assessment of clinical stability and the early identification of worsening signs and symptoms. The progress of information technology should help in achieving adequate communication between hospital professionals and PCPs; outpatient clinical records should in any case comply with qualitative standards of discharge summaries for all patients taken in charge by PCPs. Systematic assessment of shared care between hospital cardiologists and PCPs will be a main objective of the outpatient HF clinic network in the near future.

  2. Key elements of successful care process of patients with heart symptoms in an emergency care - could an ERP system help?

    Science.gov (United States)

    Kontio, Elina; Korvenranta, Heikki; Lundgren-Laine, Heljä; Salanterä, Sanna

    2009-01-01

    The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.

  3. Shock from heart device often triggers further health care needs

    Science.gov (United States)

    ... in terms of care and cost, to help define the potential benefit of smarter ways to program ... best way possible,” he said. “We have the technology to do that today.” The findings may be ...

  4. Spectrum of Congenital Heart Diseases in Eastern Nepal: A tertiary care hospital experience

    Directory of Open Access Journals (Sweden)

    Prashant Shah

    2017-01-01

    Full Text Available Background & Objectives: Congenital heart diseases are neglected especially in world’s poorest nations and appear to be ignored and unexplored dimension of health. The exact prevalence and spectrum of congenital heart diseases in Nepal is largely unknown. The aim of this study was to describe the local experience on the magnitude and the pattern of congenital heart disease in order to increase the awareness of the public and health policy makers on its burden in Nepal.Materials & Methods: This is an observational hospital based study carried out in a tertiary care hospital in Eastern Nepal. The duration of this study was from April 2015 to July 2016. The echocardiography reports of all patients clinically suspected of having congenital heart disease were retrieved, and their diagnostic details were extracted. Only patients of day one of life to 14 years of age were included. Congenital heart diseases like bicuspid aortic valve, mitral valve prolapse and various inherited cardiomyopathies were excluded.Results: A total of 330 echocardiograms were performed for clinically suspected congenital heart disease.  The mean age of study population was 22.31±34.08 months with male to female ratio of 1.2:1. 23% of clinically suspected congenital heart disease cases turned out to have normal echocardiography. Acyanotic congenital heart disease was most common (81.5% followed by cyanotic congenital heart disease (14.2% and obstructive congenital heart disease (4.3%. Atrial septal defect was found to be the most common form of acyanotic congenital heart disease (52% which was followed by ventricular septal defect (28.8% and patent ductus arteriosus (14.8%. Tetralogy of Fallot and double outlet right ventricle were the most common form of cyanotic CHD representing 44.4% of all cyanotic patients. Pulmonary stenosis was the most common obstructive congenital heart disease observed in this study population (63.6%. Rarer entities, like d-transposition of great

  5. Sociocultural influences on heart failure self-care among an ethnic minority black population.

    Science.gov (United States)

    Dickson, Victoria Vaughan; McCarthy, Margaret M; Howe, Alexandra; Schipper, Judith; Katz, Stuart M

    2013-01-01

    Heart failure (HF) places a disproportionate burden on ethnic minority populations, including blacks, who have the highest risk of developing HF and experience poorer outcomes. Self-care, which encompasses adherence to diet, medication, and symptom management, can significantly improve outcomes. However, HF self-care is notoriously poor in ethnic minority black populations. Because culture is central to the development of self-care, we sought to describe the self-care practices and sociocultural influences of self-care in an ethnic minority black population with HF. In this mixed-methods study, 30 black patients with HF (mean [SD] age, 59.63 [15] years; 67% New York Heart Association class III) participated in interviews about self-care, cultural beliefs, and social support and completed standardized instruments measuring self-care and social support. Thematic content analysis revealed themes about sociocultural influences of self-care. Qualitative and quantitative data were integrated in the final analytic phase. Self-care was very poor (standardized mean [SD] Self-care of Heart Failure Index [SCHFI] maintenance, 60.05 [18.12]; SCHFI management, 51.19 [18.98]; SCHFI confidence, 62.64 [8.16]). The overarching qualitative theme was that self-care is influenced by cultural beliefs, including the meaning ascribed to HF, and by social norms. The common belief that HF was inevitable ("all my people have bad hearts") or attributed to "stress" influenced daily self-care. Spirituality was also linked to self-care ("the doctor may order it but I pray on it"). Cultural beliefs supported some self-care behaviors like medication adherence. Difficulty reconciling cultural preferences (favorite foods) with the salt-restricted diet was evident. The significant relationship of social support and self-care (r = 0.451, P = .01) was explicated by the qualitative data. Social norms interfered with willingness to access social support, and "selectivity" in whom individuals confided led

  6. Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    C.Y. Hua

    2017-09-01

    Full Text Available Chronic heart failure (CHF is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of heart failure index and short form health survey 12, respectively. Further, cardiac function was assessed by measuring left ventricular ejection fraction (LVEF and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP, and by the 6-min walking test. Clinical and demographic characteristics of patients in the control and CCM groups were statistically equivalent. Compared with usual care, CCM significantly enhanced self-care abilities of patients with CHF, including self-care maintenance, self-care management and self-care confidence (all P<0.05. The physical and mental quality of life was also significantly improved by CCM (P<0.01 or P<0.05. Compared with usual care, CCM significantly increased the LVEF (P<0.01, decreased the NT-proBNP level (P<0.01, and enhanced exercise capacity (P<0.001. In conclusion, CCM improved the self-care, quality of life and cardiac function of patients with CHF compared with usual care.

  7. Engaging African and Caribbean Immigrants in HIV Testing and Care in a Large US City: Lessons Learned from the African Diaspora Health Initiative.

    Science.gov (United States)

    Kwakwa, Helena A; Wahome, Rahab; Goines, Djalika S; Jabateh, Voffee; Green, Arraina; Bessias, Sophia; Flanigan, Timothy P

    2017-08-01

    The lifting in 2010 of the HIV entry ban eliminated an access point for HIV testing of the foreign-born. The African Diaspora Health Initiative (ADHI) was developed to examine alternative pathways to testing for African and Caribbean persons. The ADHI consists of Clinics Without Walls (CWW) held in community settings. HIV testing is offered to participants along with hypertension and diabetes screening. A survey is administered to participants. Descriptive data were analyzed using SAS 9.2. Between 2011 and 2015, 4152 African and Caribbean individuals participated in 352 CWW. Participants were mostly (67.7 %) African. HIV rates were lowest in Caribbean women (0.4 %) and highest in Caribbean men (8.4 %). Efforts to engage African and Caribbean communities in HIV testing are important given the elimination of the HIV entry ban and continued immigration to the US from areas of higher prevalence. The ADHI offers a successful model of engagement.

  8. Palliative care for those with heart failure: nurses' knowledge, attitude, and preparedness to practice.

    Science.gov (United States)

    Kim, Sanghee; Hwang, Won Ju

    2014-04-01

    Palliative care is an important element of holistic care but has received little attention in cardiac disease patients. The purpose of the paper is (a) to investigate nurses' knowledge of palliative care, attitudes toward care of the dying, coping with death, and preparedness to practice palliative care for those with heart failure, and (b) to evaluate influencing factors on preparedness to practice on palliative care. A cross-sectional descriptive design employed a structured questionnaire that tested nurses' knowledge, attitude, coping, and preparedness to practice on palliative care for patients with heart failure. Ninety nurses in two tertiary university hospitals in South Korea participated in the survey. Data were analyzed with descriptive statistics, correlation, and multiple regression. Results showed low levels of knowledge reported (an average of 48.3% correct answers), attitude (134.8±110.1), coping (117.2±24.3), and preparedness to practice (17.3±4.7) relating to palliative care. The extent of knowledge was related to both attitudes and coping. These attitudes and coping skills were related to preparedness to practice. The multiple regression analysis showed that preparedness to practice was explained by coping and attitude (R (2) =0.46, F=6.1, pPalliative care training is urgently needed to improve knowledge, attitude, coping, and preparedness to practice. Guidance to assist healthcare professionals involved in palliative care for those with cardiac disease needs to be developed and provided.

  9. Impact of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary care veterinarians.

    Science.gov (United States)

    Lefbom, Bonnie K; Peckens, Neal K

    2016-07-01

    OBJECTIVE To assess the effects of in-person collaborative care by primary care veterinarians (pcDVMs) and board-certified veterinary cardiologists (BCVCs) on survival time of dogs after onset of congestive heart failure (CHF) and on associated revenue for the attending pcDVMs. DESIGN Retrospective cohort study. ANIMALS 26 small-breed dogs treated for naturally occurring CHF secondary to myxomatous mitral valve disease at a multilocation primary care veterinary hospital between 2008 and 2013. PROCEDURES Electronic medical records were reviewed to identify dogs with confirmed CHF secondary to myxomatous mitral valve disease and collect information on patient care, survival time, and pcDVM revenue. Data were compared between dogs that received collaborative care from the pcDVM and a BCVC and dogs that received care from the pcDVM alone. RESULTS Dogs that received collaborative care had a longer median survival time (254 days) than did dogs that received care from the pcDVM alone (146 days). A significant positive correlation was identified between pcDVM revenue and survival time for dogs that received collaborative care (ie, the longer the dog survived, the greater the pcDVM revenue generated from caring for that patient). CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that collaborative care provided to small-breed dogs with CHF by a BCVC and pcDVM could result in survival benefits for affected dogs and increased revenue for pcDVMs, compared with care provided by a pcDVM alone.

  10. Revision of Immediate Post-Open Heart Surgery Education for Critical Care RNs.

    Science.gov (United States)

    Mowry, Marianne J; Gabel, Mollie A

    2015-11-01

    Responding to the complex nature of critical care is imperative, as extensive clinical judgment is required during those vital moments when patients are experiencing complications related to open heart surgery, post-vessel bypass, or valve replacement. Critical care registered nurses must rely on evidence-based foundational knowledge and skills particular to cardiovascular pathophysiology, hemodynamic monitoring, and medications. This article reports on the critical care educator's revision of the immediate post-open heart surgery curriculum. Mixed educational methods within the plan were foundational to develop clinicians for competent care of these complex patients (within the first 8 hours). The revision included experiential learning and learner centeredness to bolster the learner's confidence, reduce the time to competence, and, most important, ensure positive patient outcomes. Kirkpatrick's classic four-level model provided the framework for evaluation. Lessons learned were discussed following the program initiation. Copyright 2015, SLACK Incorporated.

  11. Ultrasonographic views for the screening of congenital heart defects in the first level of care

    International Nuclear Information System (INIS)

    Garcia Guevara, Carlos; Arenciabia Faife, Jakeline; Ley Vega, Lisset

    2009-01-01

    Congenital heart diseases are the main cause of infant mortality for congenital malformations in our country and they are the defects that more usually escape diagnosis in ultrasonographic screening, especially if we consider that associated risk factors call for a fetal echocardiogram are not identified in most pregnant women with fetuses affected with a heart disease. With this paper, we intend to bring within reach of both the specialists dedicated to this activity in primary care and the Masters in Genetic Counseling a review article about the principal aspects to be evaluated in each of the three echocardiography views that are used in Cuba as part of screening these defects, as well as the main signs of suspicion of congenital heart diseases that give reason for having a pregnant woman referred to the immediately higher level of care

  12. Primary palliative care for heart failure: what is it? How do we implement it?

    Science.gov (United States)

    Gelfman, Laura P; Kavalieratos, Dio; Teuteberg, Winifred G; Lala, Anuradha; Goldstein, Nathan E

    2017-09-01

    Heart failure (HF) is a chronic and progressive illness, which affects a growing number of adults, and is associated with a high morbidity and mortality, as well as significant physical and psychological symptom burden on both patients with HF and their families. Palliative care is the multidisciplinary specialty focused on optimizing quality of life and reducing suffering for patients and families facing serious illness, regardless of prognosis. Palliative care can be delivered as (1) specialist palliative care in which a palliative care specialist with subspecialty palliative care training consults or co-manages patients to address palliative needs alongside clinicians who manage the underlying illness or (2) as primary palliative care in which the primary clinician (such as the internist, cardiologist, cardiology nurse, or HF specialist) caring for the patient with HF provides the essential palliative domains. In this paper, we describe the key domains of primary palliative care for patients with HF and offer some specific ways in which primary palliative care and specialist palliative care can be offered in this population. Although there is little research on HF primary palliative care, primary palliative care in HF offers a key opportunity to ensure that this population receives high-quality palliative care in spite of the growing numbers of patients with HF as well as the limited number of specialist palliative care providers.

  13. Development and testing of the European Heart Failure Self-Care Behaviour Scale

    NARCIS (Netherlands)

    Jaarsma, T; Stromberg, A; Martensson, J; Dracup, K

    Background: Improvement of self-care behaviour is an aim of several non-pharmacological nurse-led management programmes for patients with heart failure. These programmes are often evaluated based on their effects on readmission, costs and quality of life. It is, however, also important to know how

  14. The Burden of Care: Mothers’ Experiences of Children with Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Sakinne Sabzevari

    2016-10-01

    Full Text Available Background: Mothers play a key role in caring for their sick children. Their experiences of care were influenced by culture, rules, and the system of health and care services. There are few studies on maternal care of children with congenital heart disease. Also, each of them has studied a particular aspect of care. The present research aimed to understand care experiences of mothers of children with congenital heart disease. Methods: A conventional content analysis was used to obtain rich data. The goal of content analysis is “to provide knowledge and deeper understanding of the phenomenon under the study”. The study was conducted in Kerman, Iran in 2014, on mothers of children with CHD. The purposive sampling technique was used to select the participants. Participants were 14 mothers of children with CHD and one father and one nurse of open heart surgery unit, from two hospitals affiliated with Kerman University of Medical Sciences. Eighteen semi-structured interviews were constructed. Data were analyzed using conventional content analysis. MAXQDA 2007 software (VERBI GmbH, Berlin, Germany was used to classify and manage the coding. Constant comparative method was done for data analysis. The reliability and validity of the findings, including the credibility, confirm ability, dependability, and transferability, were assessed. Results: According to the content analysis, the main theme was the catastrophic burden of child care on mothers that included three categories: 1 the tension resulting from the disease, 2 involvement with internal thoughts, and 3 difficulties of care process Conclusion: The results of this study may help health care professionals to provide supportive and educational packages to the patients, mothers and Family members until improving the management of patient’s care.

  15. Mentorship: the heart and soul of health care leadership

    OpenAIRE

    Hawkins, Joellen

    2010-01-01

    Joellen W Hawkins1, Holly B Fontenot21William F Connell School of Nursing, Boston College, Auburndale, MA, USA; 2William F Connell School of Nursing, Boston College, Chestnut Hill, MA, USAAbstract: The key to the development of leaders for the health care professions is mentoring. Both leaders and mentors need to develop their own self-knowledge, strategic visions for their own careers, engage in risk-taking, express creativity through all aspects of their lives, feel inspired and inspire oth...

  16. Psychometric testing of the self-care of heart failure index.

    Science.gov (United States)

    Riegel, Barbara; Carlson, Beverly; Moser, Debra K; Sebern, Marge; Hicks, Frank D; Roland, Virginia

    2004-08-01

    Self-care is believed to improve outcomes in heart failure (HF) patients. However, research testing this assumption is hampered by difficulties in measuring self-care. The purpose of this study was to evaluate the psychometric properties of a revised instrument measuring self-care in persons with HF, the Self-Care of Heart Failure Index (SCHFI). The SCHFI is a self-report measure comprised of 15 items rated on a 4-point response scale and divided into 3 subscales. Psychometric testing was done using data from 760 HF patients (age 70.36 +/- 12.3 years, 51% male) from 7 sites in the United States. Reliability of the SCHFI (alpha.76) was adequate. Reliability of the Self-Care Maintenance subscale was lower than desired (alpha.56) but the reliability of the other subscales was adequate: Self-Care Management (alpha.70) and Self-Care Self-Confidence (alpha.82). Construct validity was supported with satisfactory model fit on confirmatory factor analysis (NFI=.69, CFI.73). Construct validity was supported further with significant total and subscale (all P Self-Care Maintenance subscale was expected because the items reflect behaviors known to vary in individuals. The reliability and validity of the SCHFI are sufficient to support its use in clinical research.

  17. Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care.

    Science.gov (United States)

    Boscart, Veronique M; Heckman, George A; Huson, Kelsey; Brohman, Lisa; Harkness, Karen I; Hirdes, John; McKelvie, Robert S; Stolee, Paul

    2017-09-01

    Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, 'Enhancing Knowledge and Interprofessional Care for Heart Failure', was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention's acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.

  18. Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries

    Directory of Open Access Journals (Sweden)

    J. Norberto W. Dachs

    2002-06-01

    Full Text Available Objective. To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods. A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income per capita, sex, age group (children, adults, and older adults, and place of residence (urban vs. rural area. For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. Results. Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small differences between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. Conclusions. Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self-reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these

  19. Patterns of Palliative Care Referral in Patients Admitted With Heart Failure Requiring Mechanical Ventilation.

    Science.gov (United States)

    Wiskar, Katie J; Celi, Leo Anthony; McDermid, Robert C; Walley, Keith R; Russell, James A; Boyd, John H; Rush, Barret

    2018-04-01

    Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P care ( P care. The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.

  20. Patient participation in patients with heart failure receiving structured home care--a prospective longitudinal study.

    Science.gov (United States)

    Näsström, Lena; Jaarsma, Tiny; Idvall, Ewa; Årestedt, Kristofer; Strömberg, Anna

    2014-12-18

    Patient participation is important for improving outcomes, respect for self-determination and legal aspects in care. However, how patients with heart failure view participation and which factors may be associated with participation is not known. The aim of this study was therefore to describe the influence of structured home care on patient participation over time in patients diagnosed with heart failure, and to explore factors associated with participation in care. The study had a prospective pre-post longitudinal design evaluating the influence of structured home care on participation in patients at four different home care units. Patient participation was measured using 3 scales and 1 single item. Self-care behavior, knowledge, symptoms of depression, socio- demographic and clinical characteristics were measured to explore factors associated with patient participation. Repeated measure ANOVA was used to describe change over time, and stepwise regression analyses were used to explore factors associated with patient participation. One hundred patients receiving structured heart failure home care were included. Mean age was 82 years, 38 were women and 80 were in New York Heart Association functional class III. One aspect of participation, received information, showed a significant change over time and had increased at both six and twelve months. Better self-care behavior was associated with all four scales measuring different aspects of participation. Experiencing lower degree of symptoms of depression, having better knowledge, being of male sex, being of lower age, cohabiting and having home help services were associated with one or two of the four scales measuring different aspects of participation. Patients experienced a fairly high level of satisfaction with participation in care at baseline, and there was a significant improvement over time for participation with regard to received information after being admitted to structured home care. Higher level of

  1. Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI).

    Science.gov (United States)

    Vaughan Dickson, Victoria; Lee, Christopher S; Yehle, Karen S; Mola, Ana; Faulkner, Kenneth M; Riegel, Barbara

    2017-02-01

    Although coronary heart disease (CHD) requires a significant amount of self-care, there are no instruments available to measure self-care in this population. The purpose of this study was to test the psychometric properties of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI). Using the Self-Care of Chronic Illness theory, we developed a 22-item measure of maintenance, management, and confidence appropriate for persons with stable CHD and tested it in a convenience sample of 392 adults (62% male, mean age 61.4 ± 9.6 years). Factorial validity was tested with confirmatory factor analysis. Convergent validity was tested with the Medical Outcomes Study MOS-SAS Specific Adherence Scale and the Decision Making Competency Inventory (DMCI). Cronbach alpha and factor determinacy scores (FDS) were calculated to assess reliability. Two multidimensional self-care scales were confirmed: self-care maintenance included "consultative behaviors" (e.g., taking medicines as prescribed) and "autonomous behaviors" (e.g., exercising 30 minute/day; FDS = .87). The multidimensional self-care management scale included "early recognition and response" (e.g., recognizing symptoms) and "delayed response" (e.g., taking an aspirin; FDS = .76). A unidimensional confidence factor captured confidence in each self-care process (α = .84). All the self-care dimensions were associated with treatment adherence as measured by the MOS-SAS. Only self-care maintenance and confidence were associated with decision-making (DCMI). These findings support the conceptual basis of self-care in patients with CHD as a process of maintenance that includes both consultative and autonomous behaviors, and management with symptom awareness and response. The SC-CHDI confidence scale is promising as a measure of self-efficacy, an important factor influencing self-care. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update.

    Science.gov (United States)

    Jaarsma, Tiny; Cameron, Jan; Riegel, Barbara; Stromberg, Anna

    2017-04-01

    As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful. Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients. Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.

  3. A study to investigate the impact of an education and counselling program on self-care and care dependency in patients with heart failure

    OpenAIRE

    Köberich, Stefan

    2015-01-01

    Patients with chronic heart failure (CHF) with a lack of self-care behaviors risk care dependency and re-hospitalization. Patient education sessions improve self-care behaviors, reduce CHF symptoms and increase quality of life (QoL). Research in Germany has demonstrated the effect of patient education on different outcome parameters. However, the effect of patient education on disease-related self-care behaviors and care dependency in acute care settings has not been evaluated yet. This wo...

  4. Self-care confidence may be more important than cognition to influence self-care behaviors in adults with heart failure: Testing a mediation model.

    Science.gov (United States)

    Vellone, Ercole; Pancani, Luca; Greco, Andrea; Steca, Patrizia; Riegel, Barbara

    2016-08-01

    Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding. The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. Secondary analysis of data from a descriptive study. Three out-patient sites in Pennsylvania and Delaware, USA. A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929-.968; root mean squared error of approximation range: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care. Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population. Copyright © 2016 Elsevier Ltd. All

  5. Family caregivers' experiences of caring for patients with heart failure: a descriptive, exploratory qualitative study.

    Science.gov (United States)

    Etemadifar, Shahram; Bahrami, Masoud; Shahriari, Mohsen; Farsani, Alireza Khosravi

    2015-06-01

    Living with heart failure is a complex situation for family caregivers. Many studies addressing the challenges faced by heart failure family caregivers have already been conducted in Western societal settings. Sociocultural factors and perspectives influence the family caring experience and roles. The ethnic/culturally based differences in family caring behavior make this a subject worth further exploration and clarification. This study explores the experiences of family caregivers in Iran of caring for patients with heart failure. A descriptive, exploratory, and qualitative approach was applied to gain authentic insight into the experiences of participants. Purposive sampling was used to recruit 21 family caregivers from three educational hospitals in Isfahan, Iran. Data were collected using semistructured interviews and field notes. Interviews and field notes were transcribed verbatim and concurrently analyzed. Three major themes emerged from the analysis of the transcripts: caregiver uncertainty, lack of familial and organizational support, and Allah-centered caring. Participants believed that they did not have the basic knowledge related to their disease and drugs. In addition, they received little guidance from the healthcare team. Lack of support and insurance as well as financial issues were major problems faced by the caregivers. They accepted the providence of Allah and noted that Allah always helps them accomplish their caregiving responsibilities. The care performed by the caregivers of patients with heart failure exceeds their individual capabilities. Nurses, other healthcare providers, and health policy makers may use the findings of this study to develop more effective programs to address these challenges and to provide more effective support.Sociocultural factors and perspectives were the primary factors affecting the caregiving experiences of participants in this study. Improved understanding of these factors and perspectives will help healthcare

  6. Does Diagnosis Make a Difference? Comparing Hospice Care Satisfaction in Matched Cohorts of Heart Failure and Cancer Caregivers.

    Science.gov (United States)

    MacKenzie, Meredith A; Meghani, Salimah H; Buck, Harleah G; Riegel, Barbara

    2015-12-01

    Half of heart failure patients will die within five years of diagnosis, making them an ideal population for hospice to reach. Yet hospice originated in oncology, and problems have been noted with the enrollment of heart failure patients. Whether caregiver satisfaction, a key quality measure in hospice, differs between heart failure and cancer caregivers is unknown. We aimed to determine whether diagnosis makes a difference in satisfaction with hospice care in matched cohorts of heart failure caregivers and cancer caregivers. This was a national cohort study, using caregiver responses to the Family Evaluation of Hospice Care (FEHC) survey. Heart failure and cancer caregivers were matched via propensity scoring. The relationship between diagnosis and caregiver satisfaction was examined across the domains of symptom management, emotional support, caregiver teaching, coordination of care, and global satisfaction, both before and after matching via logistic regression. One-to-one matching with calipers yielded 7730 matched pairs out of an original sample of 8175 heart failure caregivers and 24,972 cancer caregivers. Significant differences were found in caregiver teaching, emotional support, coordination of care, and global satisfaction prior to matching, but the effect sizes were small. All differences disappeared after matching. High rates of dissatisfaction with caregiver teaching (42%) and emotional support (30%) were found in both cohorts. The diagnosis of heart failure, in and of itself, does not appear to make a difference in informal caregiver satisfaction with hospice care. Hospice provides high-quality care for patients, but improvements are needed in caring for the caregiver.

  7. Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization.

    Science.gov (United States)

    Comín-Colet, Josep; Enjuanes, Cristina; Lupón, Josep; Cainzos-Achirica, Miguel; Badosa, Neus; Verdú, José María

    2016-10-01

    Despite advances in the treatment of heart failure, mortality, the number of readmissions, and their associated health care costs are very high. Heart failure care models inspired by the chronic care model, also known as heart failure programs or heart failure units, have shown clinical benefits in high-risk patients. However, while traditional heart failure units have focused on patients detected in the outpatient phase, the increasing pressure from hospital admissions is shifting the focus of interest toward multidisciplinary programs that concentrate on transitions of care, particularly between the acute phase and the postdischarge phase. These new integrated care models for heart failure revolve around interventions at the time of transitions of care. They are multidisciplinary and patient-centered, designed to ensure continuity of care, and have been demonstrated to reduce potentially avoidable hospital admissions. Key components of these models are early intervention during the inpatient phase, discharge planning, early postdischarge review and structured follow-up, advanced transition planning, and the involvement of physicians and nurses specialized in heart failure. It is hoped that such models will be progressively implemented across the country. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  8. Heart failure patients’ experiences with continuity of care and its relation to medication adherence: a cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients’ experiences with continuity of care, and its relation to medication adherence. Methods We collected data from 327 primary care patients with chronic heart failure. Experienced continuity of care was measured using a patient questionnaire and by reviewing patients’ medical records. Continuity of care was defined as a multidimensional concept including personal continuity (seeing the same doctor every time), team continuity (collaboration between care providers in general practice) and cross-boundary continuity (collaboration between general practice and hospital). Medication adherence was measured using a validated patient questionnaire. The relation between continuity of care and medication adherence was analysed by using chi-square tests. Results In total, 53% of patients stated not seeing any care provider in general practice in the last year concerning their heart failure. Of the patients who did contact a care provider in general practice, 46% contacted two or more care providers. Respectively 38% and 51% of patients experienced the highest levels of team and cross-boundary continuity. In total, 14% experienced low levels of team continuity and 11% experienced low levels of cross-boundary continuity. Higher scores on personal continuity were significantly related to better medication adherence (p continuity and medication adherence. Conclusions A small majority of patients that contacted a care provider in general practice for their heart failure, contacted only one care provider. Most heart failure patients experienced high levels of collaboration between care providers in general practice and between GP and cardiologist. However, in a considerable number of patients, continuity of care

  9. Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure.

    Science.gov (United States)

    Vellone, Ercole; Fida, Roberta; D'Agostino, Fabio; Mottola, Antonella; Juarez-Vela, Raul; Alvaro, Rosaria; Riegel, Barbara

    2015-11-01

    Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care. The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. A secondary analysis of data from a cross-sectional study. Outpatient heart failure clinics in 28 Italian provinces. 628 Italian heart failure patients. We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data. Participants were 73 years old on average (SD=11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index=1.0; root mean square error of approximation=0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management. Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Maddox, Thomas M; Albert, Nancy M; Borden, William B; Curtis, Lesley H; Ferguson, T Bruce; Kao, David P; Marcus, Gregory M; Peterson, Eric D; Redberg, Rita; Rumsfeld, John S; Shah, Nilay D; Tcheng, James E

    2017-04-04

    The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented. © 2017 American Heart Association, Inc.

  11. Tailoring consumer resources to enhance self-care in chronic heart failure.

    Science.gov (United States)

    Driscoll, Andrea; Davidson, Patricia; Clark, Robyn; Huang, Nancy; Aho, Zoe

    2009-08-01

    Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patients who can effectively self-manage their symptoms through lifestyle modification and adherence to complex medication regimens will experience less hospitalisations and other adverse events. The purpose of this paper is to explain how providing evidence-based information, using patient education resources, can support self-care. Self-care relates to the activities that individuals engage in relation to health seeking behaviours. Supporting self-care practices through tailored and relevant information can provide patients with resources and advice on strategies to manage their condition. Evidence-based approaches to improve adherence to self-care practices in patients with heart failure are not often reported. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Also a lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines. However these issues need to be addressed to improve self-management skills. Recently the Heart Foundation CHF consumer resource was updated based on evidence-based national clinical guidelines. The aim of this resource is to help consumers improve understanding of the disease, reduce uncertainty and anxiety about what to do when symptoms appear, encourage discussions with local doctors, and build confidence in self-care management. Evidence-based CHF patient education resources promote self-care practices and early detection of symptom change that may reduce hospitalisations and improve the quality of life for people with CHF.

  12. [ANMCO/SIC Consensus document: The heart failure network: organization of outpatient care].

    Science.gov (United States)

    Aspromonte, Nadia; Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

    2016-01-01

    Changing demographics and an increasing burden of multiple chronic comorbidities in western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of-hospital phases of HF. The needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for hospitalized HF and those followed up at HF clinics.The Working Group on Heart Failure of the Italian Association of Hospital Cardiologists (ANMCO) has drafted a consensus document for the organization of a national HF care network. The aims of this document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among healthcare professionals. In this document, HF clinics are classified into three groups: 1) community HF clinics, devoted to the management of stable patients in strict liaison with primary care, regular re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, 2) hospital HF clinics, that target both new-onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for medicine units and community clinics; 3) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. These different types of HF clinics are integrated in a dedicated network for the management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multiprofessional providers to ensure continuity of care. This consensus document is expected to

  13. [Assessment instruments for the measurement of the health-related self-care of patients with heart failure].

    Science.gov (United States)

    Haasenritter, Jörg; Panfil, Eva-Maria

    2008-08-01

    Heart Failure is a frequent disease that is accompanied by much suffering for the patients and high costs for the health care system. An improvement of the health-related self-care is supposed to improve the outcomes of patients with heart failure. In order to evaluate the efficiency of interventions valid and reliable instruments measuring the health-related self-care are needed in practice and research. The aim of the systematic literature review is to create a synopsis of the present nursing assessment instruments for the measurement of the health-related self-care of patients with heart failure and to evaluate these instruments' reliability and validity. With a systematic literature search in three electronic databases and hand-search studies using instruments that measure the health-related self-care of patients with heart failure have been identified. The instruments are described and their reliability and validity are discussed. Five Instruments were identified: European Heart Failure Self-care Behaviour Scale (EHFScBS); Revised Heart Failure Self-care Behaviour Scale (rHFScBS); Heart Failure Self-Care Inventory (HFS-CI), Self-Management of Heart Failure Scale (SMHF); Self-Care of Heart Failure Index (SCHFI). As far as the psychometric properties are concerned, each of these scales has its strengths and weaknesses. The EHFScBS, the HFS-CI, and the SCHFI can be recommended with restriction for use in practice and research. However, further testing in order to evaluate reliability and validity is necessary for all instruments.

  14. Improving care for patients with acute heart failure: before, during and after hospitalization.

    Science.gov (United States)

    Cowie, Martin R; Anker, Stefan D; Cleland, John G F; Felker, G Michael; Filippatos, Gerasimos; Jaarsma, Tiny; Jourdain, Patrick; Knight, Eve; Massie, Barry; Ponikowski, Piotr; López-Sendón, José

    2014-12-01

    Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention. © 2015 Oxford PharmaGenesis Ltd.

  15. Beyond the realist turn: a socio-material analysis of heart failure self-care.

    Science.gov (United States)

    McDougall, Allan; Kinsella, Elizabeth Anne; Goldszmidt, Mark; Harkness, Karen; Strachan, Patricia; Lingard, Lorelei

    2018-01-01

    For patients living with chronic illnesses, self-care has been linked with positive outcomes such as decreased hospitalisation, longer lifespan, and improved quality of life. However, despite calls for more and better self-care interventions, behaviour change trials have repeatedly fallen short on demonstrating effectiveness. The literature on heart failure (HF) stands as a case in point, and a growing body of HF studies advocate realist approaches to self-care research and policymaking. We label this trend the 'realist turn' in HF self-care. Realist evaluation and realist interventions emphasise that the relationship between self-care interventions and positive health outcomes is not fixed, but contingent on social context. This paper argues socio-materiality offers a productive framework to expand on the idea of social context in realist accounts of HF self-care. This study draws on 10 interviews as well as researcher reflections from a larger study exploring health care teams for patients with advanced HF. Leveraging insights from actor-network theory (ANT), this study provides two rich narratives about the contextual factors that influence HF self-care. These descriptions portray not self-care contexts but self-care assemblages, which we discuss in light of socio-materiality. © 2018 Foundation for the Sociology of Health & Illness.

  16. Care of Preschoolers with Congenital Heart Disease by Kindergarten and Nursery Teachers in Japan.

    Science.gov (United States)

    Tabata, Hisae

    2017-09-01

    The purpose of this study was to elucidate the involvement of kindergarten and nursery school teachers with young children with congenital heart disease. The study was designed as a qualitative descriptive study. Interviews of kindergarten and nursery school teachers with experience in the care and education of young children with congenital heart disease were conducted, during which they described their experience. Verbatim transcripts of the interviews were prepared, and the content was categorized. The study participants were 11 kindergarten and nursery school teachers. Extracted from the content of the interviews of the study participants were 282 codes, 33 subcategories, 6 categories, and 2 major categories. In their responses, the teachers indicated that they had been "Providing care for the children while seeking ways to avoid special treatment in a group setting." In addition, they established a "Framework for school-parent cooperation in order to promptly accommodate the wishes of parents" of these children. The study showed that the kindergarten and nursery school teachers involved other pupils and monitored the condition of children with congenital heart disease to avoid special treatment of the children in the group setting. In addition, the teachers established a framework for cooperation between the school and parents. In the future, these findings will be used to create a nursing support model for the group life of young children with congenital heart disease.

  17. Pilot Program to Improve Self-Management of Patients with Heart Failure by Redesigning Care Coordination

    Directory of Open Access Journals (Sweden)

    Jessica D. Shaw

    2014-01-01

    Full Text Available Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF. Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

  18. Patterns and predictors of patient and caregiver engagement in heart failure care: a multi-level dyadic study.

    Science.gov (United States)

    Lee, Christopher S; Vellone, Ercole; Lyons, Karen S; Cocchieri, Antonello; Bidwell, Julie T; D'Agostino, Fabio; Hiatt, Shirin O; Alvaro, Rosaria; Buck, Harleah G; Riegel, Barbara

    2015-02-01

    Heart failure is a burdensome clinical syndrome, and patients and their caregivers are responsible for the vast majority of heart failure care. This study aimed to characterize naturally occurring archetypes of patient-caregiver dyads with respect to patient and caregiver contributions to heart failure self-care, and to identify patient-, caregiver- and dyadic-level determinants thereof. Dyadic analysis of cross-sectional data on patients and their caregivers. Outpatient heart failure clinics in 28 Italian provinces. 509 Italian heart failure patients and their primary caregivers. Multilevel and mixture modeling were used to generate dyadic averages and incongruence in patient and caregiver contributions to heart failure self-care and identify common dyadic archetypes, respectively. Three distinct archetypes were observed. 22.4% of dyads were labeled as novice and complementary because patients and caregivers contributed to different aspects of heart failure self-care that was generally poor; these dyads were predominantly older adults with less severe heart failure and their adult child caregivers. 56.4% of dyads were labeled as inconsistent and compensatory because caregivers reported greater contributions to the areas of self-care most insufficient on the part of the patients; patients in these dyads had the highest prevalence of hospitalizations for heart failure in the past year and the fewest limitations to performing activities of daily living independently. Finally, 21.2% of dyads were labeled as expert and collaborative because of high contributions to all aspects of heart failure self-care, the best relationship quality and lowest caregiver strain compared with the other archetypes; patients in this archetype were likely the sickest because they also had the worst heart failure-related quality of life. Three distinct archetypes of dyadic contributions to heart failure care were observed that represent a gradient in the level of contributions to self-care

  19. The genetics of congenital heart disease… understanding and improving long-term outcomes in congenital heart disease: a review for the general cardiologist and primary care physician.

    Science.gov (United States)

    Simmons, M Abigail; Brueckner, Martina

    2017-10-01

    This review has two purposes: to provide an updated review of the genetic causes of congenital heart disease (CHD) and the clinical implications of these genetic mutations, and to provide a clinical algorithm for clinicians considering a genetics evaluation of a CHD patient. A large portion of congenital heart disease is thought to have a significant genetic contribution, and at this time a genetic cause can be identified in approximately 35% of patients. Through the advances made possible by next generation sequencing, many of the comorbidities that are frequently seen in patients with genetic congenital heart disease patients can be attributed to the genetic mutation that caused the congenital heart disease. These comorbidities are both cardiac and noncardiac and include: neurodevelopmental disability, pulmonary disease, heart failure, renal dysfunction, arrhythmia and an increased risk of malignancy. Identification of the genetic cause of congenital heart disease helps reduce patient morbidity and mortality by improving preventive and early intervention therapies to address these comorbidities. Through an understanding of the clinical implications of the genetic underpinning of congenital heart disease, clinicians can provide care tailored to an individual patient and continue to improve the outcomes of congenital heart disease patients.

  20. The Situation-Specific Theory of Heart Failure Self-Care: Revised and Updated.

    Science.gov (United States)

    Riegel, Barbara; Dickson, Victoria Vaughan; Faulkner, Kenneth M

    2016-01-01

    Since the situation-specific theory of heart failure (HF) self-care was published in 2008, we have learned much about how and why patients with HF take care of themselves. This knowledge was used to revise and update the theory. The purpose of this article was to describe the revised, updated situation-specific theory of HF self-care. Three major revisions were made to the existing theory: (1) a new theoretical concept reflecting the process of symptom perception was added; (2) each self-care process now involves both autonomous and consultative elements; and (3) a closer link between the self-care processes and the naturalistic decision-making process is described. In the revised theory, HF self-care is defined as a naturalistic decision-making process with person, problem, and environmental factors that influence the everyday decisions made by patients and the self-care actions taken. The first self-care process, maintenance, captures those behaviors typically referred to as treatment adherence. The second self-care process, symptom perception, involves body listening, monitoring signs, as well as recognition, interpretation, and labeling of symptoms. The third self-care process, management, is the response to symptoms when they occur. A total of 5 assumptions and 8 testable propositions are specified in this revised theory. Prior research illustrates that all 3 self-care processes (ie, maintenance, symptom perception, and management) are integral to self-care. Further research is greatly needed to identify how best to help patients become experts in HF self-care.

  1. Development of self-care educational material for patients with heart failure in Japan: a pilot study.

    Science.gov (United States)

    Kato, Naoko; Kinugawa, Koichiro; Sano, Miho; Seki, Satomi; Kogure, Asuka; Kobukata, Kihoko; Ochiai, Ryota; Wakita, Sanae; Kazuma, Keiko

    2012-06-01

    This study assessed the need for information regarding heart failure and self-care, developed self-care educational material, and investigated the feasibility of the material. A total of 22 hospitalized heart failure patients (mean age: 63 years) completed a self-administered questionnaire. We found that more than 90% of patients desired information, particularly about heart failure symptoms, time to notify healthcare providers, prognosis, and exercise/physical activity. After examining the eight existing brochures for Japanese heart failure patients, we developed self-care educational material. This was based on heart failure guidelines and on the results of our inquiry regarding information needs. Finally, a pilot study was conducted in nine hospitalized heart failure patients (mean age: 57 years). None of the patients had difficulty reading or understanding the educational material. The self-administrated questionnaire survey revealed that comprehension of the following improved after the educational sessions with the material: heart failure symptoms, medication, weighing, sodium intake, and fluid intake (P failure patients have a great need for information about heart failure. Our pilot study suggests that the material was readable and had a beneficial effect on heart failure comprehension. © 2012 Blackwell Publishing Asia Pty Ltd.

  2. An interprofessional collaborative practice approach to transform heart failure care: An overview.

    Science.gov (United States)

    Zierler, Brenda K; Abu-Rish Blakeney, Erin; O'Brien, Kevin D; Teams, Ipcp Heart Failure

    2018-01-17

    Interprofessional collaborative practice (IPCP) approaches to health care are increasingly recognized as necessary to achieve the Triple Aim-improved health of the population, improved patient care experience, and improved affordability of care. This paper introduces and provides an overview of an interprofessional intervention to improve a healthcare team, healthcare system, and patient outcomes for hospitalized patients with heart failure. In this paper, we describe the overall project resulting from a workforce training grant and the proposed series of future papers resulting from the interprofessional intervention. Collectively, these papers will describe the results of a unique IPCP approach on team, system, and patient outcomes as well as describe and compare organizational and leadership traits that affect collaborative practice. Our hope is that the intervention approaches, evaluation results, and lessons learned described in these papers will help further the efforts to spread IPCP approaches to transforming health care.

  3. [Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure].

    Science.gov (United States)

    del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación

    2016-02-01

    To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. Implementing telemonitoring in heart failure care : Barriers from the perspectives of patients, healthcare professionals and healthcare organizations

    NARCIS (Netherlands)

    Boyne, J.J.; Vrijhoef, H.J.M.

    2013-01-01

    The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various

  5. Construct validity of the Chinese version of the Self-care of Heart Failure Index determined using structural equation modeling.

    Science.gov (United States)

    Kang, Xiaofeng; Dennison Himmelfarb, Cheryl R; Li, Zheng; Zhang, Jian; Lv, Rong; Guo, Jinyu

    2015-01-01

    The Self-care of Heart Failure Index (SCHFI) is an empirically tested instrument for measuring the self-care of patients with heart failure. The aim of this study was to develop a simplified Chinese version of the SCHFI and provide evidence for its construct validity. A total of 182 Chinese with heart failure were surveyed. A 2-step structural equation modeling procedure was applied to test construct validity. Factor analysis showed 3 factors explaining 43% of the variance. Structural equation model confirmed that self-care maintenance, self-care management, and self-care confidence are indeed indicators of self-care, and self-care confidence was a positive and equally strong predictor of self-care maintenance and self-care management. Moreover, self-care scores were correlated with the Partners in Health Scale, indicating satisfactory concurrent validity. The Chinese version of the SCHFI is a theory-based instrument for assessing self-care of Chinese patients with heart failure.

  6. Caribbean landscapes and their biodiversity

    Science.gov (United States)

    A. E. Lugo; E. H. Helmer; E. Santiago Valentín

    2012-01-01

    Both the biodiversity and the landscapes of the Caribbean have been greatly modified as a consequence of human activity. In this essay we provide an overview of the natural landscapes and biodiversity of the Caribbean and discuss how human activity has affected both. Our Caribbean geographic focus is on the insular Caribbean and the biodiversity focus is on the flora,...

  7. Measuring self-care in patients with heart failure: A review of the psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS).

    Science.gov (United States)

    Sedlar, Natasa; Socan, Gregor; Farkas, Jerneja; Mårtensson, Jan; Strömberg, Anna; Jaarsma, Tiny; Lainscak, Mitja

    2017-07-01

    The aim of this study was to review and evaluate the evidence related to psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS) that was developed and tested to measure health maintenance behaviours of heart failure (HF) patients and translated into several languages. PRISMA guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect), to identify relevant studies. A literature search was undertaken in November 2015. An integrative review, aiming to bring together all evidence relating to the psychometric properties (validity, reliability) of the EHFScBS was conducted. 13 eligible studies were included. The results showed content, discriminant and convergent validity of the 9- and 12-item scale across the samples, while the factor structure of both versions of the scale was inconsistent. Most commonly used reliability estimates (Cronbach's alpha) of the total scale were satisfactory. Overall, published data demonstrate satisfactory psychometric properties of the EHFScBS, indicating that the scale is a reliable and valid tool for measuring health maintenance behaviours of HF patients. Taking the findings regarding the factorial structure of the scale into account, we recommend the use of the total EHFScBS score or scores on specific items. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. 'Who is on your health-care team?' Asking individuals with heart failure about care team membership and roles.

    Science.gov (United States)

    LaDonna, Kori A; Bates, Joanna; Tait, Glendon R; McDougall, Allan; Schulz, Valerie; Lingard, Lorelei

    2017-04-01

    Complex, chronically ill patients require interprofessional teams to address their multiple health needs; heart failure (HF) is an iconic example of this growing problem. While patients are the common denominator in interprofessional care teams, patients have not explicitly informed our understanding of team composition and function. Their perspectives are crucial for improving quality, patient-centred care. To explore how individuals with HF conceptualize their care team, and perceive team members' roles. Individuals with advanced HF were recruited from five cities in three Canadian provinces. Individuals were asked to identify their HF care team during semi-structured interviews. Team members' titles and roles, quotes pertaining to team composition and function, and frailty criteria were extracted and analysed using descriptive statistics and content analysis. A total of 62 individuals with HF identified 2-19 team members. Caregivers, nurses, family physicians and cardiologists were frequently identified; teams also included dentists, foot care specialists, drivers, housekeepers and spiritual advisors. Most individuals met frailty criteria and described participating in self-management. Individuals with HF perceived being active participants, not passive recipients, of care. They identified teams that were larger and more diverse than traditional biomedical conceptualizations. However, the nature and importance of team members' roles varied according to needs, relationships and context. Patients' degree of agency was negotiated within this context, causing multiple, sometimes conflicting, responses. Ignoring the patient's role on the care team may contribute to fragmented care. However, understanding the team through the patient's lens - and collaborating meaningfully among identified team members - may improve health-care delivery. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  9. Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience.

    Science.gov (United States)

    Chang, Ling-Yin; Wu, Shan-Ying; Chiang, Chern-En; Tsai, Pei-Shan

    2017-06-01

    Despite the recognition of the negative effects of depressive symptoms on self-care confidence and self-care maintenance in patients with heart failure, little is known about the moderating role of resilience underlying these relations. To explore whether depressive symptoms affect self-care maintenance through self-care confidence and whether this mediating process was moderated by resilience. The sample comprised 201 community-dwelling and medically stable patients with echocardiographically documented heart failure. A moderated mediation model was conducted to test whether self-care confidence mediated the association between depressive symptoms and self-care maintenance, and whether resilience moderated the direct and indirect effects of depressive symptoms after adjustment for covariates. Depressive symptoms reduced self-care maintenance indirectly by decreasing self-care confidence (indirect effect: -0.22, 95% confidence interval: -0.36, -0.11), and this pathway was only significant for patients with moderate and high levels and not with low levels of resilience. Resilience also moderated the direct effects of depressive symptoms on self-care maintenance such that the negative association between depressive symptoms and self-care maintenance was reversed by the existence of high resilience. Resilience moderated the direct and indirect effects of depressive symptoms through self-care confidence on self-care maintenance in heart failure patients. Efforts to improve self-care maintenance by targeting depressive symptoms may be more effective when considering self-care confidence in patients with moderate to high levels of resilience.

  10. Depression in primary care patients with coronary heart disease: baseline findings from the UPBEAT UK study.

    Directory of Open Access Journals (Sweden)

    Paul Walters

    Full Text Available An association between depression and coronary heart disease is now accepted but there has been little primary care research on this topic. The UPBEAT-UK studies are centred on a cohort of primary patients with coronary heart disease assessed every six months for up to four years. The aim of this research was to determine the prevalence and associations of depression in this cohort at baseline.Participants with coronary heart disease were recruited from general practice registers and assessed for cardiac symptoms, depression, quality of life and social problems.803 people participated. 42% had a documented history of myocardial infarction, 54% a diagnosis of ischaemic heart disease or angina. 44% still experienced chest pain. 7% had an ICD-10 defined depressive disorder. Factors independently associated with this diagnosis were problems living alone (OR 5.49, 95% CI 2.11-13.30, problems carrying out usual activities (OR 3.71, 95% CI 1.93-7.14, experiencing chest pain (OR 3.27, 95% CI 1.58-6.76, other pains or discomfort (OR 3.39, 95% CI 1.42-8.10, younger age (OR 0.95 per year 95% CI 0.92-0.98.Problems living alone, chest pain and disability are important predictors of depression in this population.

  11. Mortality-related resource utilization in the inpatient care of hypoplastic left heart syndrome.

    Science.gov (United States)

    Danford, David A; Karels, Quentin; Kulkarni, Aparna; Hussain, Aysha; Xiao, Yunbin; Kutty, Shelby

    2015-10-22

    Quantifying resource utilization in the inpatient care of congenital heart diease is clinically relevant. Our purpose is to measure the investment of inpatient care resources to achieve survival in hypoplastic left heart syndrome (HLHS), and to determine how much of that investment occurs in hospitalizations that have a fatal outcome, the mortality-related resource utilization fraction (MRRUF). A collaborative administrative database, the Pediatric Health Information System (PHIS) containing data for 43 children's hospitals, was queried by primary diagnosis for HLHS admissions of patients ≤21 years old during 2004-2013. Institution, patient age, inpatient deaths, billed charges (BC) and length of stay (LOS) were recorded. In all, 11,122 HLHS admissions were identified which account for total LOS of 277,027 inpatient-days and $3,928,794,660 in BC. There were 1145 inpatient deaths (10.3%). LOS was greater among inpatient deaths than among patients discharged alive (median 17 vs. 12, p providers and consumers that current practices often result in major resource expenditure for inpatient care of HLHS that does not result in survival to hospital dismissal. They highlight the need for data-driven critical review of standard practices to identify patterns of care associated with success, and to modify approaches objectively.

  12. The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure.

    Science.gov (United States)

    Joynt, Karen E; Orav, E John; Jha, Ashish K

    2011-01-18

    Congestive heart failure (CHF) is common and costly, and outcomes remain suboptimal despite pharmacologic and technical advances. To examine whether hospitals with more experience in caring for patients with CHF provide better, more efficient care. Retrospective cohort study. 4095 hospitals in the United States. Medicare fee-for-service patients with a primary discharge diagnosis of CHF. Hospital Quality Alliance CHF process measures; 30-day, risk-adjusted mortality rates; 30-day, risk-adjusted readmission rates; and costs per discharge. National Medicare claims data from 2006 to 2007 were used to examine the relationship between hospital case volume and quality, outcomes, and costs for patients with CHF. Hospitals in the low-volume group had lower performance on the process measures (80.2%) than did medium-volume (87.0%) or high-volume (89.1%) hospitals (P costs. Similar, though smaller, relationships were found between case volume and both mortality and costs in the medium- and high-volume hospital groups. Analysis was limited to Medicare patients 65 years or older. Risk adjustment was performed by using administrative data. Experience with managing CHF, as measured by an institution's volume, is associated with higher quality of care and better outcomes for patients but a higher cost. Understanding which practices employed by high-volume institutions account for these advantages can help improve quality of care and clinical outcomes for all patients with CHF. American Heart Association.

  13. Antecedents of Self-Care in Adults with Congenital Heart Defects

    Science.gov (United States)

    McCabe, Nancy; Dunbar, Sandra B.; Butler, Javed; Higgins, Melinda; Book, Wendy; Reilly, Carolyn

    2015-01-01

    Background Adults with congenital heart defects (ACHD) face long-term complications related to prior surgery, abnormal anatomy, and acquired cardiovascular conditions. Although self-care is an important part of chronic illness management, few studies have explored self-care in the ACHD population. The purpose of this study is to describe self-care and its antecedents in the ACHD population. Methods Persons with moderate or severe ACHD (N=132) were recruited from a single ACHD center. Self-care (health maintenance behaviors, monitoring and management of symptoms), and potential antecedents including sociodemographic and clinical characteristics, ACHD knowledge, behavioral characteristics (depressive symptoms and self-efficacy), and family-related factors (parental overprotection and perceived family support) were collected via self-report and chart review. Multiple regression was used to identify antecedents of self-care maintenance, monitoring, and management. Results Only 44.7%, 27.3%, and 23.3% of participants performed adequate levels of self-care maintenance, monitoring and management, respectively. In multiple regression analysis, self-efficacy, education, gender, perceived family support, and comorbidities explained 25% of the variance in self-care maintenance (R2=.248, F(5, 123)=9.44, p<.001). Age, depressive symptoms, self-efficacy, and NYHA Class explained 23% of the variance in self-care monitoring (R2=.232, F(2, 124)=10.66, p<.001). Self-efficacy and NYHA Class explained 9% of the variance in self-care management (R2=.094, F(2, 80)=5.27, p=.007). Conclusions Low levels of self-care are common among persons with ACHD. Multiple factors, including modifiable factors of self-efficacy, depressive symptoms, and perceived family support, are associated with self-care and should be considered in designing future interventions to improve outcomes in the ACHD population. PMID:26340127

  14. A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness.

    Science.gov (United States)

    Riegel, Barbara; Dickson, Victoria V; Hoke, Linda; McMahon, Janet P; Reis, Brendali F; Sayers, Steven

    2006-01-01

    Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging. Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 +/- 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness. Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources). An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.

  15. [Consensus on improving the care integrated of patients with acute heart failure].

    Science.gov (United States)

    Llorens, Pere; Manito Lorite, Nicolás; Manzano Espinosa, Luis; Martín-Sánchez, Francisco Javier; Comín Colet, Josep; Formiga, Francesc; Jacob, Javier; Delgado Jiménez, Juan; Montero-Pérez-Barquero, Manuel; Herrero, Pablo; López de Sá Areses, Esteban; Pérez Calvo, Juan Ignacio; Masip, Josep; Miró, Òscar

    2015-01-01

    Acute heart failure (AHF) requires considerable use of resources, is an economic burden, and is associated with high complication and mortality rates in emergency departments, on hospital wards, or outpatient care settings. Diagnosis, treatment, and continuity of care are variable at present, leading 3 medical associations (for cardiology, internal medicine, and emergency medicine) to undertake discussions and arrive at a consensus on clinical practice guidelines to support those who manage AHF and encourage standardized decision making. These guidelines, based on a review of the literature and clinical experience with AHF, focus on critical points in the care pathway. Regarding emergency care, the expert participants considered the initial evaluation of patients with signs and symptoms that suggest AHF, the initial diagnosis, first decisions about therapy, monitoring, assessment of prognosis, and referral criteria. For care of the hospitalized patient, the group developed a protocol for essential treatment. Objectives for the management and treatment of AHF on discharge were also covered through the creation or improvement of multidisciplinary care systems to provide continuity of care.

  16. Collaborative engagement with colleagues may provide better care for 'heart-sink' patients

    DEFF Research Database (Denmark)

    Kjær, Niels Kristian; Stolberg, Bent; Coles, Colin

    2015-01-01

    INTRODUCTION: In this article we show how a group of general practitioners' (GPs') professionalism was enhanced through collaborative engagement. Complexity, uncertainty and so-called 'heart-sink' patients are naturally embedded in clinical practice. GPs need to deal with, and even embrace......, uncertainty, enabling them to provide patient-centred care. METHODS: A relatively fixed group of Danish GPs have met regularly for more than 14 years, discussing difficult and complex cases. Their experiences were researched through two focus group interviews using semi-structured interviews comprising open...... and closed questions, which were audiotaped and transcribed. The qualitative findings were analysed employing grounded theory principles. RESULTS: Participation in the GP group was perceived to have had a positive impact on participants' personal and professional lives by reducing the number of 'heart...

  17. How do depressive symptoms influence self-care among an ethnic minority population with heart failure?

    Science.gov (United States)

    Dickson, Victoria Vaughan; McCarthy, Margaret M; Katz, Stuart M

    2013-01-01

    Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF. In this mixed methods study, 30 Black patients (mean age 59.63 SD +/- 15 years; 60% male) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care, depression, and physical functioning. Thematic content analysis was used to explore the meaning of depression and elicit themes about how depressive symptoms affect daily self-care practices. Qualitative and quantitative data were integrated in the final analytic phase. Self-care was very poor in the sample. Forty percent of the sample had evidence of depressive symptoms (PHQ-9 > or = 10; mean 7.59 +/- 5.29, range 0 to 22). Individuals with depressive symptoms had poorer self-care (P = .029). In the qualitative data, individuals described depressive mood as "feeling blue... like I failed." "Overwhelming" sadness and fatigue influenced self-care and resulted in treatment delays. For many, spirituality was central to coping with sadness. Few discussed depressive feelings with health care providers. Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, since depression influences self-care and minority populations continue to experience poorer outcomes.

  18. Caregivers' contributions to heart failure self-care: a systematic review.

    Science.gov (United States)

    Buck, Harleah G; Harkness, Karen; Wion, Rachel; Carroll, Sandra L; Cosman, Tammy; Kaasalainen, Sharon; Kryworuchko, Jennifer; McGillion, Michael; O'Keefe-McCarthy, Sheila; Sherifali, Diana; Strachan, Patricia H; Arthur, Heather M

    2015-02-01

    The purpose of this study was to conduct a systematic review answering the following questions: (a) what specific activities do caregivers (CGs) contribute to patients' self-care in heart failure (HF)?; and (b) how mature (or developed) is the science of the CG contribution to self-care? MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Library and ClinicalTrials.gov were searched using the terms heart failure and caregiv* as well as the keywords 'careers', 'family members' and 'lay persons' for studies published between 1948 and September 2012. Inclusion criteria for studies were: informal CGs of adult HF patients-either as dependent/independent variable in quantitative studies or participant in qualitative studies; English language. Exclusion criteria for studies were: formal CGs; pediatric, adult congenital, or devices or transplant CGs; mixed diagnosis; non-empiric reports or reports publishing duplicate results. Each study was abstracted and confirmed by two authors. After CG activities were identified and theoretically categorized, an analysis across studies was conducted. Forty papers were reviewed from a pool of 283 papers. CGs contribute substantively to HF patients' self-care characterized from concrete (weighing the patient) to interpersonal (providing understanding). Only two studies attempted to quantify the impact of CGs' activities on patients' self-care reporting a positive impact. Our analysis provides evidence for a rapidly developing science that is based largely on observational research. To our knowledge, this is the first systematic review to examine CGs' contributions in depth. Informal caregivers play a major role in HF self-care. Longitudinal research is needed to examine the impact of CGs' contributions on patient self-care outcomes. © The European Society of Cardiology 2013.

  19. Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

    Directory of Open Access Journals (Sweden)

    Tait GR

    2015-08-01

    Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team

  20. Shared heart failure knowledge and self-care outcomes in patient-caregiver dyads.

    Science.gov (United States)

    Bidwell, Julie T; Higgins, Melinda K; Reilly, Carolyn M; Clark, Patricia C; Dunbar, Sandra B

    Patient's knowledge about heart failure (HF) contributes to successful HF self-care, but less is known about shared patient-caregiver knowledge. The purpose of this analysis was to: 1) identify configurations of shared HF knowledge in patient-caregiver dyads; 2) characterize dyads within each configuration by comparing sociodemographic factors, HF characteristics, and psychosocial factors; and 3) quantify the relationship between configurations and patient self-care adherence to managing dietary sodium and HF medications. This was a secondary analysis of cross-sectional data (N = 114 dyads, 53% spousal). Patient and caregiver HF knowledge was measured with the Atlanta Heart Failure Knowledge Test. Patient dietary sodium intake was measured by 3-day food record and 24 h urine sodium. Medication adherence was measured by Medication Events Monitoring System caps. Patient HF-related quality of life was measured by the Minnesota Heart Failure Questionnaire; caregiver health-related quality of life was measured by the Short Form-12 Physical Component Summary. Patient and caregiver depression were measured with the Beck Depression Inventory-II. Patient and caregiver perceptions of caregiver-provided autonomy support to succeed in heart failure self-care were measured by the Family Care Climate Questionnaire. Multilevel and latent class modeling were used to identify dyadic knowledge configurations. T-tests and chi-square tests were used to characterize differences in sociodemographic, clinical, and psychosocial characteristics by configuration. Logistic/linear regression were used to quantify relationships between configurations and patient dietary sodium and medication adherence. Two dyadic knowledge configurations were identified: "Knowledgeable Together" (higher dyad knowledge, less incongruence; N = 85, 75%) and "Knowledge Gap" (lower dyad knowledge, greater incongruence; N = 29, 25%). Dyads were more likely to be in the "Knowledgeable Together" group if they

  1. Incidence of congenital heart disease among neonates in a neonatal unit of a tertiary care hospital

    International Nuclear Information System (INIS)

    Hussain, S.; Sabir, M.U.

    2014-01-01

    Objectives: To determine the incidence and pattern of various congenital heart disease in a neonatal unit of a tertiary care hospital. Methods: The prospective study was carried out in the neonatal unit of Combined Military Hospital, Rawalpindi, from September 2008 to August 2011. All 5800 neonates admitted with gestational age of >28 weeks irrespective of birthweight were included in the study. Neonatologist/Paediatrician carried out the neonatal examination during the first 12 hours of life. Neonates suspected of having congenital heart disease were further evaluated by pulse oxymetry, X-ray chest and echocardiography to ascertain final diagnosis and type of lesion. Data was collected on a predesigned proforma containing information regarding gender, mode of delivery, gestational age, weight at birth, family history, and associated malformations. SPSS 16 was used for statistical analysis. Results: Of the 5800 neonates, 87 (1.5%) were found to have congenital heart disease with an incidence of 15/1000. There was a male preponderance. Most common lesion was ventricular septal defect 27(31.3%), followed by atrial septal defect 20 (22.9%), patent ductus arteriosus 13 (14.94%), tetralogy of fallot 06 (6.89%), transposition of great arteries 04 (4.59%), Pulmonary stenosis 05 (5.79%) and 03(3.44%) had atrioventricular canal defects. Conclusion: Congenital heart disease is a common congenital anomaly. Its incidence varies from centre to centre due to different factors like nature of the sample, method of detection and early examination by a neonatologist/paediatrician. In this study a higher incidence is reported because it was carried out in a tertiary care unit, which is a referral hospital and all the neonates admitted in the unit were included in the study. (author)

  2. Hospital nurses' comfort in and frequency of delivering heart failure self-care education.

    Science.gov (United States)

    Albert, Nancy M; Cohen, Bonni; Liu, Xiaobo; Best, Carolyn H; Aspinwall, Laura; Pratt, Lisa

    2015-10-01

    Nurses are expected to deliver pre-discharge heart failure education in 8 content areas: what heart failure means, medications, diet, activity, weight monitoring, fluid restriction, signs/symptoms of worsening condition and signs/symptoms of fluid overload. To examine nurses' comfort in and frequency of delivering heart failure education to hospitalized patients. A multicenter, descriptive, correlational design and questionnaire methods were used. General linear models were performed to assess associations of comfort in and frequency of delivering patient education after controlling for significant nurse characteristics. Of 118 nurses, mean age was 39 ± 11.6 years, 61.9% worked on cardiac units and 58.3% spent education. Comfort in delivering education was highest for weight monitoring and lowest for activity, and was associated with nurse age (p=0.019), years in profession (p=0.004) and minutes providing pre-discharge education (p=0.003). Frequency delivering education was highest for signs/symptoms of worsening condition (mean frequency, 71.5% ± 29%) and lowest for activity (42.7% ± 29.4%) and was associated with comfort in educating patients (all peducation minutes, peducation remained associated with overall comfort in (p=0.04) and frequency of (peducation delivery. Nurses' comfort in and frequency of delivering education varied by heart failure self-care content area. Self-care education areas most important to survival and hospitalization had the lowest rates of nurse comfort and frequency. Systems and processes are needed to facilitate education delivery prior to hospital discharge. © The European Society of Cardiology 2014.

  3. Management of heart failure in primary care after implementation of the National Service Framework for Coronary Heart Disease: a cross-sectional study.

    Science.gov (United States)

    Majeed, A; Williams, J; de Lusignan, S; Chan, T

    2005-02-01

    To compare the management of heart failure with the standards set out in the National Service Framework for Coronary Heart Disease. A cross-sectional study in 26 general practices, with a combined list size of 256,188, that are members of the Kent, Surrey and Sussex Primary Care Research Network. Information was extracted on the management of 2129 patients with heart failure, of whom 2097 were aged 45 years and over. The prevalence of heart failure was 8.3 per 1000. Prevalence rates increased with age, from 0.2 per 1000 in people aged under 35 years of age to 125 per 1000 in those aged 85 years and over. Coronary heart disease (present in 47%) was the most common comorbid condition in men with heart failure, whereas hypertension (present in 46%) was the most common condition in women. Recording of cardiovascular risk factors was generally higher in younger patients than in older patients, and in men than in women. Blood pressure (92% of men and 90% of women) and smoking status (84% of men and 77% of women) were generally the best-recorded cardiovascular risk factors. Blood electrolytes were recorded in about 83% of men and 75% of women. Only 17% of men and 11% of women with heart failure had a record of undergoing an echocardiogram. Use of angiotensin-converting enzyme (ACE) inhibitors or antagonists was 76% in men with heart failure and 68% in women; lowest rates were seen in older patients. Uptake of influenza immunization was generally high, at 85% in men and 84% in women. The use of ACE inhibitors in patients with heart failure was higher than in some previous studies. However, many patients have no documentation in their computerized medical records of having undergone key investigations, such as echocardiography.

  4. Exploratory study into awareness of heart disease and health care seeking behavior among Emirati women (UAE) - Cross sectional descriptive study.

    Science.gov (United States)

    Khan, Sarah; Ali, Syed Adnan

    2017-09-26

    Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually happen in older women thus symptoms of heart disease may be masked by symptoms of chronic diseases, which could explain the delay in seeking health care and higher mortality following an ischaemic episode among women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women's health care seeking behaviour in UAE. A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18-55 years completed the questionnaire. The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p seeking health care. Interestingly, just 49.1% Emirati women believed that good quality and affordable health care was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries. Emirati women clearly lack the knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking health care that should be overcome to reduce morbidity and mortality due to heart disease among national women of UAE.

  5. ANMCO/SIC Consensus Document: cardiology networks for outpatient heart failure care

    Science.gov (United States)

    Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

    2017-01-01

    Abstract Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics. The Italian Working Group on Heart Failure has drafted a guidance document for the organisation of a national HF care network. Aims of the document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among health-care professionals. The document classifies HF outpatient clinics in three groups: (i) community HF clinics, devoted to management of stable patients in strict liaison with primary care, periodic re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, (ii) hospital HF clinics, that target both new onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for general internal medicine units and community clinics, and (iii) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. Those different types of HF clinics are integrated in a dedicated network for management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multi-professional providers to ensure continuity of care and patient empowerment

  6. ANMCO/SIC Consensus Document: cardiology networks for outpatient heart failure care.

    Science.gov (United States)

    Aspromonte, Nadia; Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

    2017-05-01

    Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics. The Italian Working Group on Heart Failure has drafted a guidance document for the organisation of a national HF care network. Aims of the document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among health-care professionals. The document classifies HF outpatient clinics in three groups: (i) community HF clinics, devoted to management of stable patients in strict liaison with primary care, periodic re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, (ii) hospital HF clinics, that target both new onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for general internal medicine units and community clinics, and (iii) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. Those different types of HF clinics are integrated in a dedicated network for management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multi-professional providers to ensure continuity of care and patient empowerment. In

  7. Australia's health care reform agenda: implications for the nurses' role in chronic heart failure management.

    Science.gov (United States)

    Betihavas, Vasiliki; Newton, Phillip J; Du, Hui Yun; Macdonald, Peter S; Frost, Steven A; Stewart, Simon; Davidson, Patricia M

    2011-08-01

    The importance of the nursing role in chronic heart failure (CHF) management is increasingly recognised. With the recent release of the National Health and Hospitals Reform Commission (NHHRC) report in Australia, a review of nursing roles in CHF management is timely and appropriate. This paper aims to discuss the implications of the NHHRC report and nursing roles in the context of CHF management in Australia. The electronic databases, Thomson Rheuters Web of Knowledge, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched using keywords including; "heart failure", "management", "Australia" and "nursing". In addition policy documents were reviewed including statements and reports from key professional organisations and Government Departments to identify issues impacting on nursing roles in CHF management. There is a growing need for the prevention and control of chronic conditions, such as CHF. This involves an increasing emphasis on specialist cardiovascular nurses in community based settings, both in outreach and inreach health service models. This review has highlighted the need to base nursing roles on evidence based principles and identify the importance of the nursing role in coordinating and managing CHF care in both independent and collaborative practice settings. The importance of the nursing role in early chronic disease symptom recognition and implementing strategies to prevent further deterioration of individuals is crucial to improving health outcomes. Consideration should be given to ensure that evidence based principles are adopted in models of nursing care. Copyright © 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Self-Care Motivation Among Patients With Heart Failure: A Qualitative Study Based on Orem's Theory.

    Science.gov (United States)

    Abotalebidariasari, Ghasem; Memarian, Robabe; Vanaki, Zohreh; Kazemnejad, Anoshirvan; Naderi, Nasim

    2016-11-01

    Initiating and adhering to self-care activities necessitate self-care motivation. This study was undertaken in Iran to explore self-care motivation among patients with heart failure (HF). This qualitative study was done in 2014 and 2015. Study participants were patients with HF and their family members who were purposively selected from Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. The study data were collected from December 2014 to May 2015 by doing in-depth semistructured face-to-face interviews and were analyzed via the directed content analysis approach. Eleven primary codes were generated which reflected motivations for self-care among patients with HF in the Iranian sociocultural context. To enhance the clarity of the findings, these primarily codes were summarized and grouped into 7 subcategories including fear of death and love of life, returning to previous physical health status and preventing or alleviating symptoms, understanding the value of self-care behaviors and trusting them, having the desire for remaining independent, relying on God, reassuring and supporting family members, and preventing family members from feeling irritation. The findings of this study indicate that patients with HF have different motivations for doing self-care activities. Fear of death, love of life, wish to return to previous health status, and prevention or alleviation of HF symptoms were the participants' strongest motivations for self-care. Understanding the motivations for self-care among patients with HF, based a holistic approach and evidence-based practice, can help nurses and physicians develop motivational programs for promoting self-care behaviors.

  9. Caribbean shallow water Corallimorpharia

    NARCIS (Netherlands)

    Hartog, J.C.den

    1980-01-01

    The present paper comprises a review of the Caribbean shallow water Corallimorpharia. Six species, belonging to four genera and three families are treated, including Pseudocorynactis caribbeorum gen. nov. spec. nov., a species with tentacular acrospheres containing the largest spirocysts ever

  10. Developing nursing expertise in caring for older advanced stage heart failure patients and their families--palliative and end-of-life care.

    Science.gov (United States)

    Pere, Katalin

    2012-01-01

    Patients living with chronic heart failure (CHF) often have poor quality of life and similar symptoms as patients with cancer. Despite this, these patients receive less specialist palliative care. Some of the major barriers in providing high-quality care for end stage CHF patients are the conflicting conceptualization of palliative care among health care professionals as a system of care delivery at the terminal phase of the illness versus philosophy of care introduced early in conjunction with life-prolonging treatments, the unpredictable nature of the illness trajectory, lack of knowledge among acute care nurses about palliative care and lack of communication with patients and their families. The aim of this article is to identify evidence-based strategies and frameworks that would aid nurses and other health care professionals in the integration of palliative care into the care path of CHF patients.

  11. Caribbean development: an overview

    Directory of Open Access Journals (Sweden)

    Paul Sutton

    2008-12-01

    Full Text Available Reviews development in the Caribbean, especially since 1990 to the present, and highlights future development prospects. Author discusses 2 reports from 2005 on present developments problems in the Caribbean region: the economics-focussed 'A time to choose: Caribbean development in the 21st century' by the World Bank, and the UN ECLAC report 'The Millennium Development Goals: a Latin American and Caribbean perspective', with a broader, also social and political, development agenda. He relates what both reports recommend for the Caribbean on the basis of their evaluations of past development. The World Bank report advocates a move toward the services sector, including tourism, offshore education, ICT services, and health services as most viable. The ECLAC report notes some social and political advances in comparison to other developing countries, but also remaining problems and inequalities. The author finds that the World Bank report's neoliberal, one-size-fits-all approach is not mindful of specific Caribbean realities, while the ECLAC study is more sensitive to local realities, and espouses a mixed economy. He thus considers the ECLAC approach preferable, but argues that it needs to go further, as it excludes Cuba and Haiti as atypical states.

  12. Heart Care in Japan: Before and After the 1995 Great Hanshin-Awaji Earthquake

    OpenAIRE

    Benedict, Timothy O.

    2016-01-01

    This paper examines the emergence of the term "heart care (kokoro no kea)" to describe the psychological support for disaster victims in the wake of the 1995 Hanshin earthquake. By comparing the usage of this term in the Yomiuri and Asahi newspapers before and after the earthquake, as well as its relationship with post-traumatic stress disorder (PTSD), this paper will show how heart care emerged in the context of hospice before expanding to include care for trauma more broadly. I will also di...

  13. Home care nurses' knowledge of evidence-based education topics for management of heart failure.

    Science.gov (United States)

    Delaney, Colleen; Apostolidis, Beka; Lachapelle, Leeanne; Fortinsky, Richard

    2011-01-01

    We primarily sought to evaluate home care nurses' knowledge of evidence-based education topics in managing heart failure (HF). Moreover, we wanted to determine if differences were evident in nurses' knowledge based on education and work experience, and to identify home care nurses' specific educational needs. A cross-sectional survey design was used. Home care nurses (n = 94) were recruited from 4 home care agencies. A previously published 20-item HF knowledge questionnaire was administered to participants, and an open-ended question determined participants' need for further HF-related education. Home care nurses' scores demonstrated a 78.9% knowledge level in overall HF education principles. The mean HF knowledge score was 15.78 (SD, ±1.69) out of a possible 20 points. Nurses scored lowest on knowledge related to asymptomatic hypotension (24.5% answered correctly), daily weight monitoring (26.6% answered correctly), and transient dizziness (30.9% answered correctly). Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. Our findings suggest that home care nurses may not be sufficiently knowledgeable in evidence-based education topics for managing HF. The results help confirm the need to develop educational programs for home care nurses in managing HF, which may lead to improved quality of patient education. Further research is needed to address specific deficits in the knowledge of home care nurses, and to determine if HF educational programs for nurses would enhance and sustain nurses' knowledge of HF management education. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Heart of the tropics: delivering evidence-based care for acute coronary syndromes in northern Australia.

    Science.gov (United States)

    Starmer, Greg; Schrale, Ryan

    2016-01-01

    Acute coronary syndromes (ACS) are life-threatening medical emergencies that require urgent treatment, posing particular challenges for systems of health care in regional and remote parts of the world characterised by large distances and widely dispersed populations and healthcare facilities. Northern Australia is such an environment. The prevalence of cardiovascular risk factors, coronary artery disease and ACS (myocardial infarction and unstable angina) in northern Australia is amongst the highest in Australia. Despite the high burden of disease, appropriate healthcare services to address these important health challenges have been inadequate. The Australian Commission on Safety and Quality in Health Care has released a Clinical Care Standard for Acute Coronary Syndromes and the National Heart Foundation of Australia has developed an ACS Capabilities Framework, which together define minimum standards of care regardless of the patient's location. Strategies such as uniform state-wide ACS clinical pathways provide guidance on how evidence-based care can be provided in a range of geographical settings and to all populations, including Indigenous Australians. The continuing evolution of cardiac catheter laboratories in Townsville, Cairns, Mackay and Darwin has facilitated improved treatment for ACS in northern Australia, and has supported the development of region-wide, integrated, multidisciplinary pathways of care. Systems of care in ACS require consideration of the perspectives of the patient (from symptom onset to long-term secondary prevention of further events), the health system ('dissolving' traditional regional silos of care to enable a higher critical mass, greater cooperation, better communication and improved efficiency) and healthcare disciplines and services (including ambulance, retrieval, local health centres and local hospitals, tertiary centres, cardiac rehabilitation and general practice).

  15. Burden of caring: risks and consequences imposed on caregivers of those living and dying with advanced heart failure.

    Science.gov (United States)

    Strömberg, Anna; Luttik, M L

    2015-03-01

    To summarize the latest research on the risks and consequences of the burden that may be imposed on informal carers of persons living and dying with advanced heart failure. A systematic search in PubMed over the period 2013-2014 ultimately revealed 24 original articles included in this review. From this research update it can be concluded that the body of knowledge increased with more studies focusing on caregivers of patients with advanced heart failure. Caregivers are important partners in care and their lives are seriously affected by the condition of advanced heart failure. Studies on the longitudinal effects of the caregiving role on caregiver's quality of life and on caregiver contributions to patient outcomes is still scarce. Focus of current research is moving towards relationship aspects. Dyadic-care typologies and the concept of incongruence within dyads in terms of conflicting perspectives on how to manage the heart failure are new and important concepts presented in studies presented in this review. Heart failure patients and their caregivers still lack sufficient palliative care and communication on prognosis and end-of-life care. More research is needed to determine the optimal time to start palliative interventions to support caregivers of patients with advanced heart failure.

  16. Multidisciplinary management of pregnancy in complex congenital heart disease: a model for coordination of care.

    Science.gov (United States)

    Harris, Rachel C; Fries, Melissa H; Boyle, Annelee; Adeniji-Adele, Hassan; Cherian, Zacharia; Klein, Nancy; John, Anitha S

    2014-01-01

    With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published. The objective of this report is to describe the process of developing a detailed pregnancy and delivery care plan for three women with complex CHD, including perspectives from the multidisciplinary specialists involved in the process. This article demonstrates that collaboration between specialists in the fields of cardiology, anesthesiology, high-risk obstetrics, maternal fetal medicine, and neonatology results in clinically successful individualized treatment plans for the management of pregnancy in complex CHD. Multidisciplinary collaboration is a crucial element in the management of pregnancy in complex CHD. We provide a template used in three cases which can serve as a model for the design of future care plans. © 2014 Wiley Periodicals, Inc.

  17. Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring.

    Science.gov (United States)

    Seto, Emily; Leonard, Kevin J; Masino, Caterina; Cafazzo, Joseph A; Barnsley, Jan; Ross, Heather J

    2010-11-29

    Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology. The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring. A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology. The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (Pmobile phones to view health information (mean 4.4, SD 0.9). Patients and clinicians were willing to use the system as long as several conditions were met, including providing a system that was easy to use with clear tangible benefits, maintaining good patient-provider communication, and not increasing clinical workload. Clinicians cited several barriers to implementation of such a system, including lack of remuneration for telephone interactions with patients and medicolegal implications. Patients and clinicians want to use mobile phone-based remote monitoring and believe that they would be able to use the technology. However, they have several reservations, such as potential increased clinical workload, medicolegal

  18. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: ... Care . 5th ed. Philadelphia, PA: Elsevier; 2017:chap 37. LeRoy S, ...

  19. Coding, recording and incidence of different forms of coronary heart disease in primary care.

    Directory of Open Access Journals (Sweden)

    Nawaraj Bhattarai

    Full Text Available To evaluate the coding, recording and incidence of coronary heart disease (CHD in primary care electronic medical records.Data were drawn from the UK General Practice Research Database. Analyses evaluated the occurrence of 271 READ medical diagnostic codes, including categories for 'Angina', 'Myocardial Infarction', 'Coronary Artery Bypass Grafting' (CABG, 'percutaneous transluminal coronary angioplasty' (PCTA and 'Other Coronary Heart Disease'. Time-to-event analyses were implemented to evaluate occurrences of different groups of codes after the index date.Among 300,020 participants aged greater than 30 years there were 75,197 unique occurrences of coronary heart disease codes in 24,244 participants, with 12,495 codes for incident events and 62,702 for prevalent events. Among incident event codes, 3,607 (28.87% were for angina, 3,262 (26.11% were for MI, 514 (4.11% for PCTA, 161 (1.29% for CABG and 4,951 (39.62% were for 'Other CHD'. Among prevalent codes, 20,254 (32.30% were for angina, 3,644 (5.81% for MI, 34,542 (55.09% for 'Other CHD' and 4,262 (6.80% for CABG or PCTA. Among 3,685 participants initially diagnosed exclusively with 'Other CHD' codes, 17.1% were recorded with angina within 5 years, 5.6% with myocardial infarction, 6.3% with CABG and 8.6% with PCTA. From 2000 to 2010, the overall incidence of CHD declined, as did the incidence of angina, but the incidence of MI did not change. The frequency of CABG declined, while PCTA increased.In primary care electronic records, a substantial proportion of coronary heart disease events are recorded with codes that do not distinguish between different clinical presentations of CHD. The results draw attention to the need to improve coding practice in primary care. The results also draw attention to the importance of code selection in research studies and the need for sensitivity analyses using different sets of codes.

  20. The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9) : a reliable and valid international instrument

    NARCIS (Netherlands)

    Jaarsma, Tiny; Arestedt, Kristofer Franzen; Martensson, Jan; Dracup, Kathleen; Stromberg, Anna

    Aims Improved self-care is the goat of many heart failure (HF) management programmes. The 12-item European Heart Failure Self-Care Behaviour Scale (EHFScB scale) was developed and tested to measure patient self-care behaviours. It is now available in 14 languages. The aim of this study was to

  1. Rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study : a cluster randomised controlled trial

    NARCIS (Netherlands)

    Valk, Mark J.; Hoes, Arno W.; Mosterd, Arend; Landman, Marcel A.; Broekhuizen, Berna D L; Rutten, Frans H.

    2015-01-01

    BACKGROUND: Heart failure (HF) is mainly detected and managed in primary care, but the care is considered suboptimal. We present the rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study. In this study we assess the

  2. Direct Telephonic Communication in a Heart Failure Transitional Care Program: An observational study.

    Science.gov (United States)

    Ota, Ken S; Beutler, David S; Sheikh, Hassam; Weiss, Jessica L; Parkinson, Dallin; Nguyen, Peter; Gerkin, Richard D; Loli, Akil I

    2013-10-01

    This study investigated the trend of phone calls in the Banner Good Samaritan Medical Center (BGSMC) Heart Failure Transitional Care Program (HFTCP). The primary goal of the HFTCP is to reduce 30-Day readmissions for heart failure patients by using a multi-pronged approach. This study included 104 patients in the HFTCP discharged over a 51-week period who had around-the-clock telephone access to the Transitionalist. Cellular phone records were reviewed. This study evaluated the length and timing of calls. A total of 4398 telephone calls were recorded of which 39% were inbound and 61% were outbound. This averaged to 86 calls per week. During the "Weekday Daytime" period, Eighty-five percent of the totals calls were made. There were 229 calls during the "Weekday Nights" period with 1.5 inbound calls per week. The "Total Weekend" calls were 10.2% of the total calls which equated to a weekly average of 8.8. Our experience is that direct, physician-patient telephone contact is feasible with a panel of around 100 HF patients for one provider. If the proper financial reimbursements are provided, physicians may be apt to participate in similar transitional care programs. Likewise, third party payers will benefit from the reduction in unnecessary emergency room visits and hospitalizations.

  3. Physician-directed heart failure transitional care program: a retrospective case review.

    Science.gov (United States)

    Ota, Ken S; Beutler, David S; Gerkin, Richard D; Weiss, Jessica L; Loli, Akil I

    2013-10-01

    Despite a variety of national efforts to improve transitions of care for patients at risk for rehospitalization, 30-day rehospitalization rates for patients with heart failure have remained largely unchanged. This is a retrospective review of 73 patients enrolled in our hospital-based, physican-directed Heart Failure Transitional Care Program (HFTCP). This study evaluated the 30- and 90- day readmission rates before and after enrollment in the program. The Transitionalist's services focused on bedside consultation prior to hospital discharge, follow-up home visits within 72 hours of discharge, frequent follow-up phone calls, disease-specific education, outpatient intravenous diuretic therapy, and around-the-clock telephone access to the Transitionalist. The pre-enrollment 30-day readmission rates for acute decompensated heart failure (ADHF) and all-cause readmission was 26.0% and 28.8%, respectively, while the post-enrollment rates for ADHF and all-cause readmission were 4.1% (P < 0.001) and 8.2% (P = 0.002), respectively. The pre-enrollment 90-day all-cause and ADHF readmission rates were 69.8%, and 58.9% respectively, while the post-enrollment rates for all-cause and ADHF were 27.3% (P < 0.001) and 16.4% (P < 0.001) respectively. Our physician-implemented HFTCP reduced rehospitalization risk for patients enrolled in the program. This program may serve as a model to assist other hospital systems to reduce readmission rates of patients with HF.

  4. Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

    Science.gov (United States)

    Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan P; Marquard, Jenna L; Bowles, Kathryn H

    2013-01-01

    Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home

  5. Quality and outcomes of heart failure care in older adults: role of multidisciplinary disease-management programs.

    Science.gov (United States)

    Ahmed, Ali

    2002-09-01

    To determine whether the management of heart failure by specialized multidisciplinary heart failure disease-management programs was associated with improved outcomes. The advent of angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone has revolutionized the management of heart failure. Randomized double-blind studies have demonstrated survival benefits of these drugs in heart failure patients. Nevertheless, in spite of these advances, heart failure continues to be a syndrome of poor outcomes.1-4 There is also evidence that a significant portion of heart failure patients does not receive this evidence-based therapy that reduces morbidity and mortality.5-7 Various disease-management programs have been proposed and tested to improve the quality of heart failure care. Most of these programs are specialized multidisciplinary heart failure clinics lead by cardiologists or heart failure specialists and conducted by nurses or nurse practitioners. Similar to the Department of Veterans Affairs (VA) multidisciplinary geriatric assessment clinics, these clinics also use many other services, including pharmacists, dietitians, physical therapists, and social workers. Some of these programs also have an affiliated home health service. Several observation studies, using mostly pre- and postcomparison designs, have demonstrated the effectiveness of these programs in the process of care, resource use, healthcare costs, and clinical outcomes in patients with heart failure.8 Risk of hospitalization was reduced by 50% to 85% in six of the studies.8 Subsequently, several randomized trials were conducted to determine the effectiveness of these programs. The purpose of this systematic review was to determine the effectiveness of these programs on mortality and hospitalization rates of heart failure patients. Published articles on human randomized trials involving specialized heart failure disease-management programs in all languages were searched using Medline from

  6. Prevalence and Predictors of Gaps in Care Among Adult Congenital Heart Disease Patients (The Health, Education and Access Research Trial: HEART-ACHD)

    Science.gov (United States)

    Gurvitz, Michelle; Valente, Anne Marie; Broberg, Craig; Cook, Stephen; Stout, Karen; Kay, Joseph; Ting, Jennifer; Kuehl, Karen; Earing, Michael; Webb, Gary; Houser, Linda; Opotowsky, Alexander; Harmon, Amy; Graham, Dionne; Khairy, Paul; Gianola, Ann; Verstappen, Amy; Landzberg, Michael

    2013-01-01

    Objective The goal of this project was to quantify the prevalence of gaps in cardiology care, identify predictors of gaps, and assess barriers to care among adult congenital heart disease (ACHD) patients. Background ACHD patients risk interruptions in care that are associated with undesired outcomes. Methods Patients (≥18years) with first presentation to an ACHD clinic completed a survey regarding gaps in, and barriers to, care. Results Among 12 ACHD centers, 922 subjects (54% female) were recruited. A >3 year gap in cardiology care was identified in 42%, with 8% having gaps longer than a decade. Mean age at first gap was 19.9 years. The majority of respondents had more than high school education, and knew their heart condition. Most common reasons for gaps included feeling well, unaware follow-up required, and complete absence from medical care. Disease complexity was predictive of gap in care with 59% of mild, 42% of moderate and 26% of severe disease subjects reporting gaps (p<0.0001). Clinic location significantly predicted gaps (p<0.0001) while gender, race, and education level did not. Common reasons for returning to care were new symptoms, referral from provider, and desire to prevent problems. Conclusions ACHD patients have gaps in cardiology care; the first lapse commonly occurred around 19 years, a time when transition to adult services is contemplated. Gaps were more common among subjects with mild and moderate diagnoses and at particular locations. These results provide a framework for developing strategies to decrease gaps and address barriers to care in the ACHD population. PMID:23542112

  7. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  8. Self-Care, Sense Of Coherence And Depression In Patients Hospitalized For Decompensated Heart Failure

    Directory of Open Access Journals (Sweden)

    Viviane Martinelli Pelegrino Ferreira

    2015-06-01

    Full Text Available OBJECTIVE To analyze the self-care behaviors according to gender, the symptoms of depression and sense of coherence and compare the measurements of depression and sense of coherence according to gender. METHOD A correlational, cross-sectional study that investigated 132 patients with decompensated heart failure (HF. Data were collected through interviews and consultation to medical records, and analyzed using the chi-square and the Student's t tests with significance level of 0.05. Participants were 75 men and 57 women, aged 63.2 years on average (SD = 13.8. RESULTS No differences in self-care behavior by gender were found, except for rest after physical activity (p = 0.017. Patients who practiced physical activity showed fewer symptoms of depression (p<0.001. There were no differences in sense of coherence according to self-care behavior and gender. Women had more symptoms of depression than men (p = 0.002. CONCLUSION Special attention should be given to women with HF considering self-care and depressive symptoms.

  9. Improvement of primary care for patients with chronic heart failure: a pilot study

    Directory of Open Access Journals (Sweden)

    Grol Richard

    2010-01-01

    Full Text Available Abstract Background Many patients with chronic heart failure (CHF receive treatment in primary care, but data have shown that the quality of care for these patients needs to be improved. We aimed to evaluate the impact and feasibility of a programme for improving primary care for patients with CHF. Methods An observational study was performed in 19 general practices in the south-eastern part of the Netherlands, evaluation involving 15 general practitioners and 77 CHF patients. The programme for improvement comprised educational and organizational components and was delivered by a trained practice visitor to the practices. The evaluation was based on case registration forms completed by health professionals and telephone interviews. Results Management relating to diet and physical exercise seemed to have improved as eight patients were referred to dieticians and five to physiotherapists. The seasonal influenza vaccination rate increased from 94% to 97% (75/77. No impact on smoking was observed. Pharmaceutical treatment was adjusted according to guideline recommendations in 12% of the patients (9/77; 7 patients started recommended medication and 2 patients received dosage adjustments. General practitioners perceived the programme to be feasible. Clinical task delegation to nurses and assistants increased in some practices, but collaboration with other healthcare providers remained limited. Conclusions The improvement programme proved to have moderate impact on patient care. Its effectiveness should be tested in a larger rigorous evaluation study using modifications based on the pilot experiences.

  10. Social media in paediatric heart disease: professional use and opportunities to improve cardiac care.

    Science.gov (United States)

    Schumacher, Kurt R; Lee, Joyce M; Pasquali, Sara K

    2015-12-01

    Social media is any type of communication utilising electronic technology that follows two guiding principles: free publishing or sharing of content and ideas and group collaboration and inter-connectedness. Over the last 10 years, social media technology has made tremendous inroads into all facets of communication. Modalities such as Facebook, YouTube, and Twitter are no longer viewed as new communication technologies. Owing to their tremendous usage, they are now common ways to conduct a dialogue with individuals and groups. Greater than 91% of teenagers and 89% of young adults routinely use social media. Further, 24% of teenagers reported being online "almost constantly". These forms of communication are readily used by individuals cared for in the field of paediatric cardiology; thus, they should carry significant interest for cardiology care providers; however, social media's influence on medicine extends beyond use by patients. It directly affects all medical providers, both users and non-users. Further, social media has the ability to improve care for patients with paediatric heart disease. This article details social media's current influence on paediatric cardiology, including considerations for professional use of social media and potential opportunities to improve cardiac care.

  11. Continuity of care in the ambulatory sector and hospital admissions among patients with heart failure in Germany.

    Science.gov (United States)

    Vogt, Verena; Koller, Daniela; Sundmacher, Leonie

    2016-03-09

    Heart failure is one of the most cost-intensive chronic diseases and the most common cause of hospitalization. More than 60% of the treatment costs of heart failure are incurred in the inpatient sector in Germany. However, hospital admissions due to heart failure are considered to be potentially avoidable through effective and continuous ambulatory care. Our aim is to examine whether continuity in ambulatory care is associated with hospitalizations due to heart failure. Using insurance claims data from Germany's biggest statutory health insurance company, we defined three measures of continuity of care: Continuity of Care Index (COCI), Usual Provider Index (UPC) and the Sequential Continuity Index (SECON). We analyzed whether these measures are associated with hospitalization due to heart failure using separate logistic regression models. We controlled for a wide range of covariates such as sex, age and the Charlson comorbidity index. Data of 382 118 heart failure patients were included in the analyses. Index values range from 0.77 to 0.89. Results of logistic regression analyses indicate that the continuity indices COCI, UPC and SECON based on visits to general practitioners (GPs), cardiologists and internists are negatively associated with the probability of hospitalization whereas of the continuity indices based on GP visits only SECON is significantly associated with hospitalization. The results indicate that the overall continuity in the ambulatory sector is high for heart failure patients in Germany. Public policy should, nevertheless, focus on increasing sequential continuity of specialist and generalist ambulatory care as this was found to be significantly associated with a reduced likelihood of hospitalization. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  12. Heart failure in sub-Saharan Africa: review of the aetiology of heart failure and the role of point-of-care biomarker diagnostics.

    Science.gov (United States)

    Glezeva, Nadezhda; Gallagher, Joe; Ledwidge, Mark; O'Donoghue, John; McDonald, Kenneth; Chipolombwe, John; Watson, Chris

    2015-05-01

    Within Africa, the burden of heart failure is significant. This arises from the increase in cardiovascular disease and associated risk factors such as hypertension and diabetes, as well as causes of heart failure which are particular to sub-Saharan Africa, such as endomyocardial fibrosis. The lack of access to echocardiography and other imaging modalities, from a cost and technical perspective, combined with the predominantly rural nature of many countries with poor transport links, means that the vast majority of people never obtain an appropriate diagnosis. Similarly, research has been limited on the causes and treatment of heart failure in Africa and in particular endemic causes such as EMF and rheumatic heart disease. This review outlines the burden of heart failure in Africa and highlights the opportunity to expand diagnosis through the use of biomarkers, in particular natriuretic peptides. This builds on the success of point-of-care testing in human immunodeficiency virus and tuberculosis which have been extensively deployed in community settings in Africa. © 2015 John Wiley & Sons Ltd.

  13. Population health status of South Asian and African-Caribbean communities in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Calvert Melanie

    2012-04-01

    Full Text Available Abstract Background Population health status scores are routinely used to inform economic evaluation and evaluate the impact of disease and/or treatment on health. It is unclear whether the health status in black and minority ethnic groups are comparable to these population health status data. The aim of this study was to evaluate health-status in South Asian and African-Caribbean populations. Methods Cross-sectional study recruiting participants aged ≥ 45 years (September 2006 to July 2009 from 20 primary care centres in Birmingham, United Kingdom.10,902 eligible subjects were invited, 5,408 participated (49.6%. 5,354 participants had complete data (49.1% (3442 South Asian and 1912 African-Caribbean. Health status was assessed by interview using the EuroQoL EQ-5D. Results The mean EQ-5D score in South Asian participants was 0.91 (standard deviation (SD 0.18, median score 1 (interquartile range (IQR 0.848 to 1 and in African-Caribbean participants the mean score was 0.92 (SD 0.18, median 1 (IQR 1 to 1. Compared with normative data from the UK general population, substantially fewer African-Caribbean and South Asian participants reported problems with mobility, usual activities, pain and anxiety when stratified by age resulting in higher average health status estimates than those from the UK population. Multivariable modelling showed that decreased health-related quality of life (HRQL was associated with increased age, female gender and increased body mass index. A medical history of depression, stroke/transient ischemic attack, heart failure and arthritis were associated with substantial reductions in HRQL. Conclusions The reported HRQL of these minority ethnic groups was substantially higher than anticipated compared to UK normative data. Participants with chronic disease experienced significant reductions in HRQL and should be a target for health intervention.

  14. Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    McCarthy, James J; Carr, Brendan; Sasson, Comilla; Bobrow, Bentley J; Callaway, Clifton W; Neumar, Robert W; Ferrer, Jose Maria E; Garvey, J Lee; Ornato, Joseph P; Gonzales, Louis; Granger, Christopher B; Kleinman, Monica E; Bjerke, Chris; Nichol, Graham

    2018-02-26

    The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). © 2018 American Heart Association, Inc.

  15. Preferred Place of Care and Death in Terminally Ill Patients with Lung and Heart Disease Compared to Cancer Patients

    DEFF Research Database (Denmark)

    Skorstengaard, Marianne H; Neergaard, Mette A; Andreassen, Pernille

    2017-01-01

    Objectives: The dual aim of this study is, first, to describe preferred place of care (PPOC) and preferred place of death (PPOD) in terminally ill patients with lung and heart diseases compared with cancer patients and second, to describe differences in level of anxiety among patients with these ......Objectives: The dual aim of this study is, first, to describe preferred place of care (PPOC) and preferred place of death (PPOD) in terminally ill patients with lung and heart diseases compared with cancer patients and second, to describe differences in level of anxiety among patients...... to be cared for and to die at home. Patients with cancer and heart diseases chose hospice as their second most common preference for both PPOC and PPOD, whereas patients with lung diseases chose nursing home and hospice equally frequent as their second most common preference. Regardless of their diagnosis...

  16. An advanced chronic heart failure day care service: a 5 year single-center experience.

    Science.gov (United States)

    Freimark, Dov; Arad, Michael; Matetzky, Shlomi; DeNeen, Isabell; Gershovitz, Liron; Morag, Nira Koren; Hochberg, Naomi; Makmal, Yafit; Shechter, Michael

    2009-07-01

    Chronic heart failure is associated with excessive hospitalizations and poor prognosis. To summarize the 5 year experience of a single-center CHF day care service, detect the cardiovascular and non-cardiovascular events, and evaluate the safety of the treatments provided. We retrospectively studied all patients admitted to the CHF day care service of the Sheba Medical Center between September 2000 and September 2005. Advanced (New York Heart Association class III-IV) CHF patients (n = 190), mean age 65 +/- 12 years and left ventricular ejection fraction 25 +/- 11%, were treated for 6 hourly biweekly visits; 77% had ischemic and 23% had nonischemic cardiomyopathy. Treatment included: intravenous diuretic combinations (91%), intermittent low dose (< or = 5 microg/kg/min) dobutamine (87%), low dose (< or = 3 microg/kg/min) dopamine (38%), intravenous iron preparation and/or blood (47%), and intravenous nitropruside (36%). Follow-up of at least 1 year from initiation of therapy was completed in 158 of 190 patients (83%). Forty-six (29.3%) died: 23% due to CHF exacerbation, 5.7% from infection, 4.4% from sudden cardiac death, 3.8% from malignancy, 2.5% from malignant arrhythmias, 1.9% from renal failure, 1.3% from stroke, and 0.6% from myocardial infarction. There were only 0.68 rehospitalizations/patient/year; the most frequent cause being CHF exacerbation (16.5%). Our study demonstrates the safety and potential benefits of a supportive day care service for advanced CHF patients. Multidrug intravenous treatment, accompanied by monitoring of electrolytes, hemoglobin and cardiac rhythm, along with education and psychological support, appear to reduce morbidity in advanced CHF patients and may have contributed to the lower than expected mortality/ hospitalization rate.

  17. Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: A multicentre cross-sectional study.

    Science.gov (United States)

    Ausili, Davide; Rebora, Paola; Di Mauro, Stefania; Riegel, Barbara; Valsecchi, Maria Grazia; Paturzo, Marco; Alvaro, Rosaria; Vellone, Ercole

    2016-11-01

    Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care. (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes. Secondary analysis of data from a multicentre cross-sectional study. Outpatient clinics from 29 Italian provinces. 1192 adults with confirmed diagnosis of heart failure. Socio-demographic and clinical data were abstracted from patients' medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p=0.12), self-care management (p=0.21) or self-care confidence (p=0.51). Age (p=0.04), number of medications (p=0.01), presence of a caregiver (p=0.04), family income (p=0.009) and self-care confidence (pdiabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in

  18. [Patients' perception of quality of emergency department care for acute heart failure: the CALPERICA study].

    Science.gov (United States)

    Miró, Òscar; Escoda, Rosa; Martín-Sánchez, Francisco Javier; Herrero, Pablo; Jacob, Javier; Alquézar, Aitor; Aguirre, Alfons; Gil, Víctor; Andueza, Juan Antonio; Llorens, Pere

    2015-06-01

    To determine perception of quality of care for acute heart failure (AHF) of patients discharged from the emergency department in comparison with the perception of admitted patients; to explore the variables associated with perception of quality. Prospective, cross-sectional case-control study in 7 emergency departments. Consecutive patients diagnosed with AHF were recruited to answer a telephone survey assessing their view of quality of physician care, nurse care, overall treatment, and degree of resolution of their problem in the emergency department. Discharged patients were also asked to state their level of agreement with the decision to send them home from the emergency department. The answers of patients who were discharged home were compared with patients who were admitted to the ward. The results were analyzed according to whether or not adverse events occurred within 30 days. A total of 1147 patients were enrolled and 1003 (87.4%) were interviewed; 253 of the patients (25.2%) were discharged home. We found no significant differences in any of the assessments (on physician or nurse care, overall treatment, or degree of resolution) between patients who were discharged home and those who were admitted. The mean (SD) overall satisfaction assessments (on a scale of 0 to 10) were 7.34 (1.38) and 7.38 (1.52), respectively, in the 2 groups (P=.66). Over 90% of those discharged home agreed with or strongly agreed with the decision. Evaluations were unrelated to whether or not adverse events occurred in the next 30 dyas. Patients with AHF have high opinions of the different components of care received in the emergency department, and their evaluations are unrelated to whether they were admitted or discharged home. Those discharged home agree with the decision and their opinion remains firm regardless of whether adverse events occur later.

  19. Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care

    Directory of Open Access Journals (Sweden)

    Francesco Chiumeo

    2015-12-01

    Full Text Available The treatment of chronic obstructive pulmonary disease (COPD and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners. The objectives were to identify: i prevalence of COPD in patients (65-98 years in the province of Trento; ii presence and incidence of heart failure (HF in COPD patients; iii early detection of other chronic diseases; and iv improving electronic medical records (EMR as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years, suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of sentinel therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the sentinel drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation.

  20. Evaluation of Quality of Life in Patients with and without Heart Failure in Primary Care.

    Science.gov (United States)

    Jorge, Antonio José Lagoeiro; Rosa, Maria Luiza Garcia; Correia, Dayse Mary da Silva; Martins, Wolney de Andrade; Ceron, Diana Maria Martinez; Coelho, Leonardo Chaves Ferreira; Soussume, William Shinji Nobre; Kang, Hye Chung; Moscavitch, Samuel Datum; Mesquita, Evandro Tinoco

    2017-09-01

    Heart failure (HF) is a major public health issue with implications on health-related quality of life (HRQL). To compare HRQL, estimated by the Short-Form Health Survey (SF-36), in patients with and without HF in the community. Cross-sectional study including 633 consecutive individuals aged 45 years or older, registered in primary care. The subjects were selected from a random sample representative of the population studied. They were divided into two groups: group I, HF patients (n = 59); and group II, patients without HF (n = 574). The HF group was divided into HF with preserved ejection fraction (HFpEF - n = 35) and HF with reduced ejection fraction (HFrEF - n = 24). Patients without HF had a mean SF-36 score significantly greater than those with HF (499.8 ± 139.1 vs 445.4 ± 123.8; p = 0.008). Functional capacity - ability and difficulty to perform common activities of everyday life - was significantly worse (p quality of life regardless of the syndrome presentation (HFpEF or HFrEF phenotype). Quality of life evaluation in primary care could help identify patients who would benefit from a proactive care program with more emphasis on multidisciplinary and social support. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).

  1. The Bridge Project Improving Heart Failure Care in Skilled Nursing Facilities

    Science.gov (United States)

    Boxer, Rebecca S.; Dolansky, Mary A.; Frantz, Megan A.; Prosser, Regina; Hitch, Jeanne A.; Piña, Ileana L.

    2011-01-01

    Introduction Re-hospitalization rates and transitions of care for patients with heart failure (HF) continue to be of prominent importance for hospital systems around the United States. Skilled nursing facilities (SNF) are pivotal sites for transition especially for older adults. The purpose of this study was to evaluate in SNFs both the 1) current state of HF management (HF admissions, protocols and staff knowledge) and 2) the acceptability and effect of a HF staff educational program Methods Four SNFs participated in the project, two the first year and two the second year. SNFs were surveyed by discipline as to HF disease management techniques. Staff were evaluated on HF knowledge and confidence in pre and post HF disease management training. Results All-cause rehospitalization rates ranged from 18% to 43% in the 2 SNF evaluated. Overall, there was a lack of identification and tracking of HF patients in all the SNFs. There were no HF-specific disease management protocols at any SNF and staff had limited knowledge of HF care. Staff pre and post test scores indicated an improvement in both staff knowledge and confidence in HF management after receiving training. Conclusion The lack of identification and tracking of patients with HF limits SNF ability to care for patients with HF. HF education for staff is likely important to effective HF management in the SNF. PMID:21450244

  2. A comparative study of the palliative care needs of heart failure and cancer patients.

    LENUS (Irish Health Repository)

    O'Leary, Norma

    2012-02-01

    AIMS: Studies suggest that patients with advanced heart failure (HF) have unmet palliative care (PC) needs. However, many of these studies have been retrospective or based on patients receiving poorly coordinated ad hoc care. We aimed to demonstrate whether the PC needs of patients with advanced HF receiving specialist multidisciplinary coordinated care are similar to cancer patients deemed to have specialist PC needs; thereby justifying the extension of specialist PC services to HF patients. METHODS AND RESULTS: This was a cross-sectional comparative cohort study of 50 HF patients and 50 cancer patients, using quantitative and qualitative methods. Both patient cohorts were statistically indistinguishable in terms of symptom burden, emotional wellbeing, and quality-of-life scores. HF patients had good access to community and social support. HF patients particularly valued the close supervision, medication monitoring, ease of access to service, telephone support, and key worker provided at the HF unit. A small subset of patients had unmet PC needs. A palliative transition point is described. CONCLUSION: HF patients should not be excluded from specialist PC services. However, the majority of their needs can be met at a HF unit. Recognition of the palliative transition point may be key to ensuring that end-of-life issues are addressed. The palliative transition point needs further evaluation.

  3. The Bridge Project: improving heart failure care in skilled nursing facilities.

    Science.gov (United States)

    Boxer, Rebecca S; Dolansky, Mary A; Frantz, Megan A; Prosser, Regina; Hitch, Jeanne A; Piña, Ileana L

    2012-01-01

    Rehospitalization rates and transitions of care for patients with heart failure (HF) continue to be of prominent importance for hospital systems around the United States. Skilled nursing facilities (SNF) are pivotal sites for transition especially for older adults. The purpose of this study was to evaluate in SNF both the (1) current state of HF management (HF admissions, protocols, and staff knowledge) and (2) the acceptability and effect of a HF staff educational program. Four SNF participated in the project, 2 the first year and 2 the second year. SNF were surveyed by discipline as to HF disease management techniques. Staff were evaluated on HF knowledge and confidence in pre- and post-HF disease management training. All-cause rehospitalization rates ranged from 18% to 43% in the 2 SNF evaluated. Overall, there was a lack of identification and tracking of HF patients in all the SNF. There were no HF-specific disease management protocols at any SNF and staff had limited knowledge of HF care. Staff pre and post test scores indicated an improvement in both staff knowledge and confidence in HF management after receiving training. The lack of identification and tracking of patients with HF limits SNF ability to care for patients with HF. HF education for staff is likely important to effective HF management in the SNF. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  4. Light-hearted death talk in a palliative day care context.

    Science.gov (United States)

    Langley-Evans, A; Payne, S

    1997-12-01

    This paper reports on an ethnographic investigation of a palliative day care unit. The aim of the study was to explore communication processes amongst patients with terminal disease, in an 'open awareness' context. The research involved participant observation over a period of 7 weeks. Detailed field notes were written and documentary information gathered on site. Analysis of the data showed that in the day care environment, patients readily talked about cancer, illness and death. Five themes were identified in the content of such 'death talk': talk about illness, symptoms and treatment, stories about illness and death, talk about patient deaths, talk regarding bereavement, and talk concerning personal mortality. In addition to content, it is maintained that the form of the patients' talk is pertinent to an understanding of the discursive context of palliative day care. It is proposed that the light-hearted and humorous nature of patient 'death talk' serves an important psychological function in allowing patients to distance themselves from their own deaths whilst simultaneously permitting an acknowledgement of their terminal condition. This suggests that the provision of an appropriate 'social' environment for patients with terminal disease may be as important to patients as one-to-one counselling by clinical nurse specialists.

  5. Building a comprehensive team for the longitudinal care of single ventricle heart defects: Building blocks and initial results.

    Science.gov (United States)

    Texter, Karen; Davis, Jo Ann M; Phelps, Christina; Cheatham, Sharon; Cheatham, John; Galantowicz, Mark; Feltes, Timothy F

    2017-07-01

    With increasing survival of children with HLHS and other single ventricle lesions, the complexity of medical care for these patients is substantial. Establishing and adhering to best practice models may improve outcome, but requires careful coordination and monitoring. In 2013 our Heart Center began a process to build a comprehensive Single Ventricle Team designed to target these difficult issues. Comprehensive Single Ventricle Team in 2014 was begun, to standardize care for children with single ventricle heart defects from diagnosis to adulthood within our institution. The team is a multidisciplinary group of providers committed to improving outcomes and quality of life for children with single ventricle heart defects, all functioning within the medical home of our heart center. Standards of care were developed and implemented in five target areas to standardize medical management and patient and family support. Under the team 100 patients have been cared for. Since 2014 a decrease in interstage mortality for HLHS were seen. Using a team approach and the tools of Quality Improvement they have been successful in reaching high protocol compliance for each of these areas. This article describes the process of building a successful Single Ventricle team, our initial results, and lessons learned. Additional study is ongoing to demonstrate the effects of these interventions on patient outcomes. © 2017 Wiley Periodicals, Inc.

  6. Point-of-care ultrasonography changes patient management following open heart surgery.

    Science.gov (United States)

    Christiansen, Lærke Kamstrup; Frederiksen, Christian Alcaraz; Juhl-Olsen, Peter; Jakobsen, Carl-Johan; Sloth, Erik

    2013-12-01

    Although pericardial effusions (PE) and pleural effusions (PLE) may lead to life-threatening respiratory and circulatory deterioration following open heart surgery the postoperative frequency is not fully recognized. The diagnosis is typically based on ultrasonography, X-ray or computer tomography and often disclosed when circulatory collapse is evident. Point-of-care (POC) ultrasonography protocols constitute a noninvasive evaluation of the cardiopulmonary status. We hypothesized that POC ultrasonography could diagnose unknown PE and PLE. Patients scheduled for open heart surgery were eligible for inclusion. Baseline evaluation including POC examination and dyspnea score was performed one day prior to surgery and repeated on the 4th and 30th postoperative day. Eighty patients were included and complete follow-up was 80%. Thirteen patients (19%) had PE on the 4th day postsurgery and 19 patients (30%) had PE on the 30th day. Ultrasonography facilitated change in management in one patient with PE requiring drainage. Forty-nine patients (70%) had PLE on the 4th day following surgery and 19 patients (30%) had PLE on the 30th postoperative day. Ultrasonography facilitated a change in management in seven patients with PLE requiring drainage. POC ultrasonography detected pathology, otherwise undisclosed, and was responsible for a change in management in a considerable number of cases.

  7. Measuring self-care in chronic heart failure: a review of the psychometric properties of clinical instruments.

    Science.gov (United States)

    Cameron, Jan; Worrall-Carter, Linda; Driscoll, Andrea; Stewart, Simon

    2009-01-01

    Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care. The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties. A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines. The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments. Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.

  8. Family partner intervention influences self-care confidence and treatment self-regulation in patients with heart failure.

    Science.gov (United States)

    Stamp, Kelly D; Dunbar, Sandra B; Clark, Patricia C; Reilly, Carolyn M; Gary, Rebecca A; Higgins, Melinda; Ryan, Richard M

    2016-08-01

    Heart failure self-care requires confidence in one's ability and motivation to perform a recommended behavior. Most self-care occurs within a family context, yet little is known about the influence of family on heart failure self-care or motivating factors. To examine the association of family functioning and the self-care antecedents of confidence and motivation among heart failure participants and determine if a family partnership intervention would promote higher levels of perceived confidence and treatment self-regulation (motivation) at four and eight months compared to patient-family education or usual care groups. Heart failure patients (N=117) and a family member were randomized to a family partnership intervention, patient-family education or usual care groups. Measures of patient's perceived family functioning, confidence, motivation for medications and following a low-sodium diet were analyzed. Data were collected at baseline, four and eight months. Family functioning was related to self-care confidence for diet (p=0.02) and autonomous motivation for adhering to their medications (p=0.05) and diet (p=0.2). The family partnership intervention group significantly improved confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four months, whereas patient-family education group and usual care did not change. Perceived confidence and motivation for self-care was enhanced by family partnership intervention, regardless of family functioning. Poor family functioning at baseline contributed to lower confidence. Family functioning should be assessed to guide tailored family-patient interventions for better outcomes. © The European Society of Cardiology 2015.

  9. Frequency of different valvular lesions of rheumatic heart disease presenting to a tertiary care hospital

    International Nuclear Information System (INIS)

    Rehman, J.U.; Shah, I.

    2015-01-01

    Rheumatic Hearth Disease (RHD) is still prevalent in our country and a great source of morbidity. This study was done with an objective to determine relative frequency of different valvular lesions of RHD presenting in a tertiary care hospital. Methods: This cross sectional study was conducted at the Cardiology Department of Hayatabad Medical Complex, Peshawar. A total of 171 cases of RHD were included through consecutive sampling technique. Results: There were 64.33% females. Mean age was 25.6 ± 6.95 years ranging from 15 to 40 years. The different percentage of valvular lesions in RHD were MR (59.06%), MS (46.78%), AR (43.85%) and mixed lesions (38.59%). Conclusion: Rheumatic heart disease is a very common disease in our community and mitral regurgitation is a predominant lesion at presentation. Females are usually affected more than males. (author)

  10. Application of a marketing concept to patient-centered care: co-producing health with heart failure patients.

    Science.gov (United States)

    Leone, Robert P; Walker, Charles A; Curry, Linda Cox; Agee, Elizabeth J

    2012-04-03

    Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

  11. Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC.

    Science.gov (United States)

    Azzolin, Karina; Mussi, Claudia Motta; Ruschel, Karen Brasil; de Souza, Emiliane Nogueira; de Fátima Lucena, Amália; Rabelo-Silva, Eneida Rejane

    2013-11-01

    The objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care. In this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented. Of the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation. NIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care. © 2013 Elsevier Inc. All rights reserved.

  12. Self-management intervention to improve self-care and quality of life in heart failure patients.

    Science.gov (United States)

    Tung, Heng-Hsin; Lin, Chun-Yu; Chen, Kuei-Ying; Chang, Chien-Jung; Lin, Yu-Ping; Chou, Cheng-Hui

    2013-01-01

    Self-management intervention is a good method to improve self-care ability, as such, to promote quality of life. However, the research focused on self-management intervention in heart failure patients in Taiwan is very limited. Therefore, the purposes of this study were to test the effectiveness of self-management intervention in patients with heart failure in Taiwan and examine the relationship between self-care ability and quality of life. A quasi-experimental design was used in this study with convenience sampling. Of the 82 subjects participating in this study, 40 of them chose to join the experimental (self-management intervention plus usual care) and 42 of them chose to join control (usual care) group. Three questionnaires were used to collect the data, which were the demographic questionnaire, the self-care questionnaire (Self-Care of HF Index V 6), and the quality of life questionnaire (Minnesota Living with Heart Failure Questionnaire). To examine the effectiveness of the intervention, self-care ability and quality of life were measured, using a pretest, 1- and 2-month follow-up assessment. Generalized estimation equations (GEE) were used to compare changes over time among groups for outcomes to ensure the effectiveness of the intervention. This study confirmed the effectiveness of the self-management intervention. The clinical provider should increase the awareness of the importance of self-management skills and self-care ability especially for heart failure patients. The designated disease-specific self-management patient book and individualize intervention should be dispensing and implementing. © 2012 Wiley Periodicals, Inc.

  13. Caribbean health Policy Briefing

    International Development Research Centre (IDRC) Digital Library (Canada)

    Caribbean health. Diversity in local food production to combat obesity. Did you know? • The World Health Organization recommends that children should eat 400 g of fruit and vegetables per day. • Drip irrigation can provide the entire water requirements for vegetable crops using 40-50% less water. • About 60% of the ...

  14. IDRC in the Caribbean

    International Development Research Centre (IDRC) Digital Library (Canada)

    Since the early 1970s, IDRC has supported the efforts of researchers in the English-speaking Caribbean to reduce poverty and inequality, restore degraded coastal ecosystems, and protect communities against disease and natural disasters. Research has helped to improve farming and fishing practices and tackle.

  15. The value of the clinical geneticist caring for adults with congenital heart disease: diagnostic yield and patients' perspective

    NARCIS (Netherlands)

    van Engelen, Klaartje; Baars, Marieke J. H.; Felix, Joyce P.; Postma, Alex V.; Mulder, Barbara J. M.; Smets, Ellen M. A.

    2013-01-01

    For adult patients with congenital heart disease (CHD), knowledge about the origin and inheritance of their CHD is important. Clinical geneticists may play a significant role in their care. We explored the diagnostic yield of clinical genetic consultation of adult CHD patients, patients' motivations

  16. Patient safety analysis of the ED care of patients with heart failure and COPD exacerbations: a multicenter prospective cohort study.

    Science.gov (United States)

    Calder, Lisa; Tierney, Sarah; Jiang, Yue; Gagné, Austin; Gee, Andrew; Hobden, Elisabeth; Vaillancourt, Christian; Perry, Jeffrey; Stiell, Ian; Forster, Alan

    2014-01-01

    For emergency department (ED) patients with acute exacerbations of heart failure and chronic obstructive pulmonary disease (COPD), we aimed to assess the adherence to evidence-based care and determine the proportion that experienced adverse events. An expert panel identified critical actions for ED care of heart failure and COPD patients based on clinical practice guidelines. We collected outcome data for discharged ED patients >age 50 with acute heart failure or COPD in a multicenter prospective cohort study at five academic EDs. We measured 3 flagged outcomes: return ED visit, admission, or death within 14 days. Three trained physician reviewers reviewed case summaries for adverse event determination (flagged outcomes related to healthcare received). We evaluated health records for adherence to the critical actions for each condition. We identified 122 (7.0%) flagged outcomes among 1,718 enrolled patients (61 heart failure, 59 COPD and 2 dual diagnoses). The mean age was 74.2 (SD 10.4) and 44.3% were female. Among 10 critical actions for heart failure and 13 for COPD, a mean proportion of 9.4/10 and 11.0/13 were adhered to respectively. We identified 12 adverse events (9.8%, 95%CI: 5.6-16.5%), all of which were deemed preventable, including 1 death. The most common contributors were unsafe disposition decisions (10/12, 83.3%) and diagnostic issues (5/12, 41.7%). Patients who died with heart failure were statistically significantly less likely to have guideline adherent care (P = .02). A small proportion of return ED visits were related to index care. We believe there is need for improvement around disposition decision making for both conditions to reduce the highly preventable and clinically significant adverse events we found. © 2013 Elsevier Inc. All rights reserved.

  17. Activities of daily living for patients with chronic heart failure: a partnership care model evaluation.

    Science.gov (United States)

    Mohammadi, Eesa; Khoshab, Hadi; Kazemnejad, Anoshirvan

    2016-05-01

    The study determined the effect of a partnership care model (PCM) on the activities of daily living (ADL) of patients with chronic heart failure (CHF). Management programs for patients with CHF are needed to optimize care. This randomized clinical trial was designed in 2011 in four wards at two Iranian hospital centers with the participation of 104 patients with CHF who had hospitalization histories. The Lawton questionnaire was used to measure the dependent variable (ADL) at baseline after 3 months. The mean difference (pre- and post-intervention) of the scores for the control (MD=0.06; SD=1.5) and experimental (MD=-2.3; SD=1.4) groups were calculated. T-test results showed that there was a significant difference in the means (p<0.05) between groups. The effect size (2.18) and standardized effect size (54.5) were also calculated. The findings suggest that centered ADL intervention based on a PCM improved the ADL of patients substantially more than other interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Organisation of care for pregnancy in patients with congenital heart disease.

    Science.gov (United States)

    Roos-Hesselink, Jolien W; Budts, Werner; Walker, Fiona; De Backer, Julie F A; Swan, Lorna; Stones, William; Kranke, Peter; Sliwa-Hahnle, Karen; Johnson, Mark R

    2017-12-01

    Improvements in surgery have resulted in more women with repaired congenital heart disease (CHD) surviving to adulthood. Women with CHD, who wish to embark on pregnancy require prepregnancy counselling. This consultation should cover several issues such as the long-term prognosis of the mother, fertility and miscarriage rates, recurrence risk of CHD in the baby, drug therapy during pregnancy, estimated maternal risk and outcome, expected fetal outcomes and plans for pregnancy. Prenatal genetic testing is available for those patients with an identified genetic defect using pregestational diagnosis or prenatal diagnosis chorionic villus sampling or amniocentesis. Centralisation of care is needed for high-risk patients. Finally, currently there are no recommendations addressing the issue of the delivery. It is crucial that a dedicated plan for delivery should be available for all cardiac patients. The maternal mortality in low-income to middle-income countries is 14 times higher than in high-income countries and needs additional aspects and dedicated care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

    Directory of Open Access Journals (Sweden)

    Denilson Campos de Albuquerque

    2015-06-01

    Full Text Available Background: Heart failure (HF is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%, dyslipidemia (36.7% and diabetes (34%. Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

  20. Early sepsis detection in critical care patients using multiscale blood pressure and heart rate dynamics.

    Science.gov (United States)

    Shashikumar, Supreeth P; Stanley, Matthew D; Sadiq, Ismail; Li, Qiao; Holder, Andre; Clifford, Gari D; Nemati, Shamim

    Sepsis remains a leading cause of morbidity and mortality among intensive care unit (ICU) patients. For each hour treatment initiation is delayed after diagnosis, sepsis-related mortality increases by approximately 8%. Therefore, maximizing effective care requires early recognition and initiation of treatment protocols. Antecedent signs and symptoms of sepsis can be subtle and unrecognizable (e.g., loss of autonomic regulation of vital signs), causing treatment delays and harm to the patient. In this work we investigated the utility of high-resolution blood pressure (BP) and heart rate (HR) times series dynamics for the early prediction of sepsis in patients from an urban, academic hospital, meeting the third international consensus definition of sepsis (sepsis-III) during their ICU admission. Using a multivariate modeling approach we found that HR and BP dynamics at multiple time-scales are independent predictors of sepsis, even after adjusting for commonly measured clinical values and patient demographics and comorbidities. Earlier recognition and diagnosis of sepsis has the potential to decrease sepsis-related morbidity and mortality through earlier initiation of treatment protocols. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Signs for early diagnosis of heart failure in primary health care

    Directory of Open Access Journals (Sweden)

    Devroey D

    2011-09-01

    Full Text Available Dirk Devroey1,2, Viviane Van Casteren11Scientific Institute of Public Health, Unit of Epidemiology, Brussels, Belgium; 2Vrije Universiteit Brussel (VUB, Department of Family Medicine, Brussels, BelgiumObjective: The current guidelines for the diagnosis of heart failure (HF are based on studies of hospital-based patients. The aim of this study is to describe the symptoms, clinical signs, and diagnostic procedures confirming the diagnosis of HF in primary health care.Materials/subjects and methods: Data were prospectively collected during a 2-year period by a nationwide network of sentinel practices. All adult patients without known HF, for which the diagnosis of HF was clinically suspected for the first time, were registered. When diagnosed, HF was confirmed after 1 month.Results: 754 patients with a suspicion of HF were recorded. The diagnosis of HF was confirmed for 74% of the patients. The average age of the patients with confirmed HF was 77.7 years, and for those without HF 75.6 years (P = 0.018. From a logistic regression, breathlessness on exercise (P < 0.001, limitations of physical activity (P = 0.003, and orthopnea (P = 0.040 were the symptoms most associated with HF. The clinical signs most associated with HF, were pulmonary rales (P < 0.001, peripheral edema (P < 0.001, and raised jugular venous pressure (P = 0.039. An electrocardiogram was performed in 75% of the cases, blood analyses in 68%, echocardiogram in 63%, chest X-ray in 61%, and determination of natriuretic peptides in 11% of the cases.Conclusion: Many clinical signs may occur in patients with HF. However, the occurrence of peripheral edema, breathlessness on exercise, or pulmonary rales, are highly suggestive for HF when diagnosed in primary health care, as is the case in hospital-admitted patients. The diagnosis of HF was often left unconfirmed by an echocardiogram and/or an electrocardiogram.Keywords: heart failure, primary health care, diagnostic clinical signs

  2. Behind the smile: qualitative study of caregivers' anguish and management responses while caring for someone living with heart failure.

    Science.gov (United States)

    Wingham, Jennifer; Frost, Julia; Britten, Nicky

    2017-07-20

    Caregivers support self-management in heart failure but often experience stress, anxiety and ill health as a result of providing care. 1. To identify the factors that contribute to the experience of anguish.2. To understand how caregivers learn to live with what is frequently a challenging and demanding role. Individual interviews with caregivers who had been caring for someone with heart failure for a minimum of 6 months. We used thematic analysis to inductively analyse transcripts. Twenty-two caregivers, from three centres in the United Kingdom, took part in individual interviews. The caregivers were aged between 39 and 84 years, and six were men. Twenty were in spousal or partner relationships. We found that caregivers often hide the extent of their emotional stress or anguish. We identified four main themes with explanatory subthemes-emotional impact (fear for the future and sense of hopelessness), role definition (changing sense of who I am, reduced resilience, learning care skills, role conflict and changing role), exclusion (exclusion by the cared-for person and by health professionals and feeling alone) and ignoring one's own health-that were associated with anguish. From these findings, we produced a caregiver needs assessment model in the context of caring for a person with heart failure. Caregivers have many unmet and hidden needs. Primary care health professionals are well placed to meet the needs of caregivers. The model may be used by health and social care professionals to identify needs and to provide caregivers with targeted practical and emotional support; and for researchers developing interventions to enhance self-management in heart failure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Secondary prevention of coronary heart disease. A survey in an Italian primary care practice.

    Science.gov (United States)

    Modesti, A; Del Papa, C; Modesti, L; Bartaloni, R; Galloni, V; Dell'omo, G; Pedrinelli, R

    2010-04-01

    Management of patients with pre-existing coronary heart disease (CHD) relies for the most part on primary care physicians, an endeavour whose success is dependent upon acceptance and day-to-day application of guideline recommendations for secondary CHD prevention. The aim of this study is to analyze the status of secondary CHD prevention in an Italian primary care practice consisting of five partnered general practitioners attending 7006 subjects aged 15 years or more (3137 males, 3869 females) in Pontedera, Tuscany. Retrieval of patients with history of CHD (previous myocardial infarction, [MI], and stable angina) from computerized records of the 5987 (2735 men, 3252 women) subjects aged 35-85 years enlisted in the practice. Patients with myocardial infarction <3 months at the time of the query were excluded. Search retrieved 153 (2.6%) subjects with history of CHD, 93 (3.4%) males and 60 (1.8%) females. Females were older and smoked more frequently than men. Antiplatelet drugs, beta-blockers, renin-angiotensin system blockers and statins were prescribed in 84%, 56%, 66% and 68% of the ischemic patients. LDL cholesterol targets of 100 and 70 mg/dL were achieved in only 60 (45%) and 11 (9%) respectively. Systolic blood pressure was above 140 mmHg in 25 out of 146 patients with available data. The surveys shows satisfactory uptake of guideline recommendations but also pitfalls in the implementation of secondary CHD prevention requirements. Targeted interventions on primary care physicians are critically needed to enhance further provider adherence to consensus guidelines for CHD risk reduction.

  4. A Randomized Trial Comparing Cardiac Rehabilitation to Standard of Care for Adults With Congenital Heart Disease.

    Science.gov (United States)

    Opotowsky, Alexander R; Rhodes, Jonathan; Landzberg, Michael J; Bhatt, Ami B; Shafer, Keri M; Yeh, Doreen DeFaria; Crouter, Scott E; Ubeda Tikkanen, Ana

    2018-03-01

    Cardiac rehabilitation (CR) improves exercise capacity and quality of life while reducing mortality in adults with acquired heart disease. Cardiac rehabilitation has not been extensively studied in adults with congenital heart disease (CHD). We performed a prospective, randomized controlled trial (NCT01822769) of a 12-week clinical CR program compared with standard of care (SOC). Participants were ≥16 years old, had moderate or severe CHD, had O 2 saturation ≥92%, and had peak O 2 consumption ([Formula: see text]) exercise capacity, physical activity, quality of life, self-reported health status, and other variables at baseline and after 12 weeks. The prespecified primary end point was change in [Formula: see text]. We analyzed data on 28 participants (aged 41.1 ± 12.1 years, 50% male), 13 randomized to CR and 15 to SOC. [Formula: see text] averaged 16.8 ± 3.8 mL/kg/min, peak work rate = 95 ± 28 W, and median Minnesota Living with Heart Failure Questionnaire (MLHFQ) score = 27 (interquartile range: 11-44). Cardiac rehabilitation participants were older (48 ± 9 years vs 36 ± 12 years; P = .01), but there were no significant between-group differences in other variables. There were no adverse events related to CR. [Formula: see text] increased in the CR group compared with SOC (+2.2 mL/kg/min, 95% confidence interval: 0.7-3.7; P = .002, age-adjusted +2.7 mL/kg/min; P = .004); there was a nonsignificant improvement in work rate (+8.1 W; P = .13). Among the 25 participants with baseline MLHFQ > 5, there was a clinically important >5-point improvement in 72.7% and 28.6% of CR and SOC participants, respectively ( P = .047). Cardiac rehabilitation was also associated with improved self-assessment of overall health ( P Cardiac rehabilitation is safe and is associated with improvement in aerobic capacity and self-reported health status compared with SOC in adults with CHD.

  5. The role of patient-held alert cards in promoting continuity of care for Heart Failure Patients.

    Science.gov (United States)

    McBride, Anne; Burey, Lorraine; Megahed, Margo; Feldman, Carolyne; Deaton, Christi

    2014-02-01

    Patients with heart failure managed by community heart failure specialist nurses (CHFSNs) may have episodes of (often unrelated) ill-health managed separately in hospital. Inadequate communication and multi-disciplinary working between these different providers can impact on the effectiveness of care. This service improvement project explored the potential of patient-held alert cards to improve communication and continuity of care for heart failure patients moving between CHFSNs and hospital settings. Alert cards were distributed to 119 patients on a community case load for presentation at hospital or emergency department. Follow-up data were obtained from practitioners and patients at 12 months. At 12 months, 38 patients from the CHFSN caseload experienced 61 hospital admissions. CHFSNs were informed of 80% of admissions by practitioners (61%) and family members (38%). They were also informed of 59% of discharges. Notification of admission by hospital staff increased from zero in the previous 12 months, to 19 notifications. CHFSNs were more involved with hospital care, and patients reported increased confidence with the alert cards. The study has shown that alert cards can increase the involvement of CHFSNs in the ongoing care and discharge planning process. They can also empower patients and carers to take an active role in their own care.

  6. PROFILE OF CONGENITAL HEART DISEASE AS DIAGNOSED BY FETAL ECHOCARDIOGRAPHY, A TERTIARY CARE EXPERIENCE

    OpenAIRE

    Venkata Arunavalli; Imamuddin; Udaykiran

    2015-01-01

    BACKGROUND : The incidence of congenital heart disease is 0.8 in 1000 live births. Fetal echo cardiography offers a chance to detect most hemodynamically significant congenital heart disease in early pregnancy, so that their management prenatally, at birth and postnatally can be planned better. OBJECTIVES : To analyze the profile of congenital heart disease as diagnosed by fetal echocardiography, in pregnant women r...

  7. Substance Abuse, Acculturation, and HIV Risk among Caribbean-Born Immigrants in the United States.

    Science.gov (United States)

    Saint-Jean, Gilbert; Dévieux, Jessy; Malow, Robert; Tammara, Hayley; Carney, Kimberly

    2011-01-01

    US immigrants of Caribbean origin are overrepresented in the HIV/AIDS prevalence statistics. Bidirectional travel between the United States and the Caribbean region by providing opportunities for sexual mixing may contribute to these high HIV rates. Caribbean immigrants face further risk because of limited health care access, social isolation, and stigma. Additionally, although substance abuse may not represent a major health issue in their countries of origin, Caribbean immigrants are composed disproportionately of adolescents who are at greatest risk of substance abuse. There is little information on the health care characteristics of these migrants, especially regarding HIV care. This article describes how the social and economic circumstances that surround the lives of people from the Caribbean and the challenges of the acculturation process have placed these individuals at risk of substance abuse and HIV infection. The article draws on findings from the literature and analysis of data from several sources.

  8. Predictors of Better Self-Care in Patients with Heart Failure after Six Months of Follow-Up Home Visits

    Science.gov (United States)

    Trojahn, Melina Maria; Ruschel, Karen Brasil; Nogueira de Souza, Emiliane; Mussi, Cláudia Motta; Naomi Hirakata, Vânia; Nogueira Mello Lopes, Alexandra; Rabelo-Silva, Eneida Rejane

    2013-01-01

    This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care. PMID:24083023

  9. Cross-sectional study of ethnic differences in physical fitness among children of South Asian, black African-Caribbean and white European origin: the Child Heart and Health Study in England (CHASE).

    Science.gov (United States)

    Nightingale, C M; Donin, A S; Kerry, S R; Owen, C G; Rudnicka, A R; Brage, S; Westgate, K L; Ekelund, U; Cook, D G; Whincup, P H

    2016-06-20

    Little is known about levels of physical fitness in children from different ethnic groups in the UK. We therefore studied physical fitness in UK children (aged 9-10 years) of South Asian, black African-Caribbean and white European origin. Cross-sectional study. Primary schools in the UK. 1625 children (aged 9-10 years) of South Asian, black African-Caribbean and white European origin in the UK studied between 2006 and 2007. A step test assessed submaximal physical fitness from which estimated VO2 max was derived. Ethnic differences in estimated VO2 max were estimated using multilevel linear regression allowing for clustering at school level and adjusting for age, sex and month as fixed effects. The study response rate was 63%. In adjusted analyses, boys had higher levels of estimated VO2 max than girls (mean difference 3.06 mL O2/min/kg, 95% CI 2.66 to 3.47, pfitness than white Europeans and black African-Caribbeans in the UK. This ethnic difference in physical fitness is at least partly explained by ethnic differences in physical activity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Women with heart failure are at high psychosocial risk: a systematic review of how sex and gender influence heart failure self-care.

    Science.gov (United States)

    Thomas, Jody R; Clark, Alexander M

    2011-03-06

    To improve patient support, it is important to understand how people view and experience Heart Failure (HF) self-care. This systematic review of qualitative studies included all published studies that examine the influence of sex and gender on HF self-care. A systematic search was done for papers (1995-2010) indexed in Ovid MEDLINE, Ovid Medline, Ovid EMBASE, Ovid PsycINFO, CSA Sociological Abstracts, OVID AARP Ageline, EBSCO Academic Search Complete, EBSCO CINAHL, EBSCO SocINDEX, ISI Web of Science: Social Sciences Citation Index and Science Citation Index Expanded, and Scopus. After screening of 537 citations, six qualitative studies identified that differences existed in perceptions of symptoms with women having less family involvement and psychosocial support around self-care. Moreover, women had considerably more negative views of the future, themselves and their ability to fulfill social self-care roles. Women with HF represent a highly vulnerable population and need more support for psychosocial wellbeing and self-care.

  11. Women with Heart Failure Are at High Psychosocial Risk: A Systematic Review of How Sex and Gender Influence Heart Failure Self-Care

    Directory of Open Access Journals (Sweden)

    Jody R. Thomas

    2011-01-01

    Full Text Available To improve patient support, it is important to understand how people view and experience Heart Failure (HF self-care. This systematic review of qualitative studies included all published studies that examine the influence of sex and gender on HF self-care. A systematic search was done for papers (1995–2010 indexed in Ovid MEDLINE, Ovid Medline, Ovid EMBASE, Ovid PsycINFO, CSA Sociological Abstracts, OVID AARP Ageline, EBSCO Academic Search Complete, EBSCO CINAHL, EBSCO SocINDEX, ISI Web of Science: Social Sciences Citation Index and Science Citation Index Expanded, and Scopus. After screening of 537 citations, six qualitative studies identified that differences existed in perceptions of symptoms with women having less family involvement and psychosocial support around self-care. Moreover, women had considerably more negative views of the future, themselves and their ability to fulfill social self-care roles. Women with HF represent a highly vulnerable population and need more support for psychosocial wellbeing and self-care.

  12. Development of a practice tool for community-based nurses: the Heart Failure Palliative Approach to Care (HeFPAC).

    Science.gov (United States)

    Strachan, Patricia H; Joy, Cathy; Costigan, Jeannine; Carter, Nancy

    2014-04-01

    Patients living with advanced heart failure (HF) require a palliative approach to reduce suffering. Nurses have described significant knowledge gaps about the disease-specific palliative care (PC) needs of these patients. An intervention is required to facilitate appropriate end-of-life care for HF patients. The purpose of this study was to develop a user-friendly, evidence-informed HF-specific practice tool for community-based nurses to facilitate care and communication regarding a palliative approach to HF care. Guided by the Knowledge to Action framework, we identified key HF-specific issues related to advanced HF care provision within the context of a palliative approach to care. Informed by current evidence and subsequent iterative consultation with community-based and specialist PC and HF nurses, a pocket guide tool for community-based nurses was created. We developed the Heart Failure Palliative Approach to Care (HeFPAC) pocket guide to promote communication and a palliative approach to care for HF patients. The HeFPAC has potential to improve the quality of care and experiences for patients with advanced HF. It will be piloted in community-based practice and in a continuing education program for nurses. The HeFPAC pocket guide offers PC nurses a concise, evidence-informed and practical point-of care tool to communicate with other clinicians and patients about key HF issues that are associated with improving disease-specific HF palliative care and the quality of life of patients and their families. Pilot testing will offer insight as to its utility and potential for modification for national and international use.

  13. Rodents of the Caribbean

    DEFF Research Database (Denmark)

    Fabre, Pierre-Henri; Mouatt, Julia Thidamarth Vilstrup; Raghavan, Maanasa

    2014-01-01

    The Capromyidae (hutias) are endemic rodents of the Caribbean and represent a model of dispersal for non-flying mammals in the Greater Antilles. This family has experienced severe extinctions during the Holocene and its phylogenetic affinities with respect to other caviomorph relatives are still ...... (Bahamas, Cuba, Jamaica) hutias. Recent divergences among these western hutias suggest Plio-Pleistocene dispersal waves associated with glacial cycles....

  14. The Role of Dyadic Confidence on Engagement in Heart Failure Care Behaviors.

    Science.gov (United States)

    Lyons, Karen S; Gelow, Jill M; Hiatt, Shirin O; Mudd, James O; Auld, Jonathan; Chien, Christopher V; Lee, Christopher S

    2017-04-26

    Increasingly, older adults and their families are expected to manage complex conditions with little support. In the case of heart failure (HF), symptom monitoring and management are critical in preventing acute exacerbations and poor clinical outcomes. The current study examined the role of dyadic confidence on engagement in HF care behaviors by patients and their spouses. A cross-sectional design was used to examine 60 couples living with HF. Three dyadic confidence variables were created to represent average level of confidence, gap in confidence, and direction of gap within each couple. A series of multilevel models were used to examine dyadic engagement in HF maintenance, management, and consulting behaviors and the role of dyadic confidence. Patients were significantly more engaged in HF maintenance behaviors than spouses; couples were more collaborative in their engagement in HF management and consulting behaviors. Average level of confidence in the dyad was significantly associated with patient engagement in all three HF behaviors. Spouse engagement was associated with more congruence in confidence and having higher levels of confidence than their partners with HF. Women were significantly more engaged in HF behaviors than men, regardless of role. The study employed a dyadic approach to HF care and a novel approach to confidence. Findings confirm the social nature of confidence and its important role in HF. Clinicians have opportunities to optimize patient outcomes by fostering greater collaboration within couples. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls.

    Science.gov (United States)

    Stauffer, Brett D; Fullerton, Cliff; Fleming, Neil; Ogola, Gerald; Herrin, Jeph; Stafford, Pamala Martin; Ballard, David J

    2011-07-25

    Randomized controlled trials have demonstrated the efficacy of nurse-led transitional care programs to reduce readmission rates for patients with heart failure; the effectiveness of these programs in real-world health care systems is less well understood. We performed a prospective study with concurrent controls to test an advanced practice nurse-led transitional care program for patients with heart failure who were 65 years or older and were discharged from Baylor Medical Center Garland (BMCG) from August 24, 2009, through April 30, 2010. We compared the effect of the program on 30-day (from discharge) all-cause readmission rate, length of stay, and 60-day (from admission) direct cost for BMCG with that of other hospitals within the Baylor Health Care System. We also performed a budget impact analysis using costs and reimbursement experience from the intervention. The intervention significantly reduced adjusted 30-day readmission rates to BMCG by 48% during the postintervention period, which was better than the secular reductions seen at all other facilities in the system. The intervention had little effect on length of stay or total 60-day direct costs for BMCG. Under the current payment system, the intervention reduced the hospital financial contribution margin on average $227 for each Medicare patient with heart failure. Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure. This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals.

  16. [Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)].

    Science.gov (United States)

    Miró, Òscar; Llorens, Pere; Escalada, Xavier; Herrero, Pablo; Jacob, Javier; Gil, Víctor; Xipell, Carolina; Sánchez, Carolina; Aguiló, Sira; Martín-Sánchez, Francisco J

    2017-07-01

    To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.

  17. Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure.

    Science.gov (United States)

    Wong, Frances Kam Yuet; So, Ching; Ng, Alina Yee Man; Lam, Po-Tin; Ng, Jeffrey Sheung Ching; Ng, Nancy Hiu Yim; Chau, June; Sham, Michael Mau Kwong

    2018-02-01

    Studies have shown positive clinical outcomes of specialist palliative care for end-stage heart failure patients, but cost-effectiveness evaluation is lacking. To examine the cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure patients as compared to the customary palliative care service. A cost-effectiveness analysis was conducted alongside a randomized controlled trial (Trial number: NCT02086305). The costs included pre-program training, intervention, and hospital use. Quality of life was measured using SF-6D. The study took place in three hospitals in Hong Kong. The inclusion criteria were meeting clinical indicators for end-stage heart failure patients including clinician-judged last year of life, discharged to home within the service area, and palliative care referral accepted. A total of 84 subjects (study = 43, control = 41) were recruited. When the study group was compared to the control group, the net incremental quality-adjusted life years gain was 0.0012 (28 days)/0.0077 (84 days) and the net incremental costs per case was -HK$7935 (28 days)/-HK$26,084 (84 days). The probability of being cost-effective was 85% (28 days)/100% (84 days) based on the cost-effectiveness thresholds recommended both by National Institute for Health and Clinical Excellence (£20,000/quality-adjusted life years) and World Health Organization (Hong Kong gross domestic product/capita in 2015, HK$328117). Results suggest that a transitional home-based palliative care program is more cost-effective than customary palliative care service. Limitations of the study include small sample size, study confined to one city, clinic consultation costs, and societal costs including patient costs and unpaid care-giving costs were not included.

  18. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Herrmann-Lingen, Christoph; de Jonge, Peter

    2010-01-01

    paired with emotional non-expression) on quality of life in primary care heart failure patients, using a prospective study design. Heart failure patients (n = 251) recruited from 44 primary care practices in Germany completed standardized questionnaires at baseline and 9 months. The prevalence of Type D......Quality of life is an important patient-centered outcome and predictor of mortality in heart failure, but little is known about the role of personality as a determinant of quality of life in this patient group. We examined the influence of Type D personality (i.e., increased negative emotions...... was 31.9%. Type D patients experienced poorer emotional (P...

  19. Current Role of Blood and Urine Biomarkers in the Clinical Care of Adults with Congenital Heart Disease.

    Science.gov (United States)

    Rajpal, Saurabh; Alshawabkeh, Laith; Opotowsky, Alexander R

    2017-06-01

    There is an increasing number of adult patients with congenital heart disease (CHD). While several biomarkers have been validated and integrated into general cardiology clinical practice, these tests are often applied to adults with CHD in the absence of disease-specific validation. Although these patients are often grouped into a single population, there is heterogeneous pathophysiology, variable disease chronicity, extensive multisystem involvement, and a low event rate relative to acquired heart disease. These stand as challenges to systematic investigation and clinical application of biomarkers for adults with CHD. This paper reviews recent studies investigating the use of biomarkers in this population, with emphasis on biomarkers applied in clinical adult CHD care. A handful of biomarkers have been integrated into adult CHD practice, such as iron studies in cyanotic heart disease and stool alpha-1 antitrypsin for diagnosis of protein losing enteropathy in the Fontan circulation. Use of kidney and liver tests has been studied in prognostication of adult CHD patients. A few other biomarkers like natriuretic peptides and troponins seem likely to provide useful information in other ACHD situations based on limited disease-specific data and extrapolation from acquired heart disease. More research is needed to support the robust validity of most existing clinical biomarkers in adult congenital cardiology practice. Until data from larger, prospectively enrolled cohorts are available, clinical use of biomarkers in these patients will require careful interpretation with attention to underlying pathophysiology, as well as detailed understanding of potential pitfalls of specific assays and clinical contexts.

  20. Preparing adolescents with heart problems for transition to adult care, 2009-2010 National Survey of Children with Special Health Care Needs.

    Science.gov (United States)

    Downing, Karrie F; Oster, Matthew E; Farr, Sherry L

    2017-07-01

    A substantial percentage of children with congenital heart disease (CHD) fail to transfer to adult care, resulting in increased risk of morbidity and mortality. Transition planning discussions with a provider may increase rates of transfer, yet little is known about frequency and content of these discussions. We assessed prevalence and predictors of transition-related discussions between providers and parents of children with special healthcare needs (CSHCN) and heart problems, including CHD. Using parent-reported data on 12- to 17-year-olds from the 2009-2010 National Survey of CSHCN, we calculated adjusted prevalence ratios (aPR) for associations between demographic factors and provider discussions on shift to adult care, future insurance, and adult healthcare needs, weighted to generate population-based estimates. Of the 5.3% of adolescents with heart problems in our sample (n = 724), 52.8% were female, 65.3% white, 62.2% privately insured, and 37.1% had medical homes. Less than 50% had parents who discussed with providers their child's future health insurance (26.4%), shift to adult care (22.9%), and adult healthcare needs (49.0%). Transition planning did not differ between children with and without heart problems (aPR range: 1.0-1.1). Among parents of CSHCN with heart problems who did not have discussions, up to 66% desired one. Compared to 1-/13-year-olds, a larger percentage of 16-/17-year-olds had parents who discussed their shift to adult care (aPR 2.1, 95% confidence interval (CI) [1.1, 3.9]), and future insurance (aPR 1.8, 95% CI [1.1, 2.9]). Having a medical home was associated with discussing adult healthcare needs (aPR 1.5, 95% CI [1.2, 1.8]) and future insurance (aPR 1.8, 95% CI [1.3, 2.6]). Nationally, less than half of adolescents with heart problems had parents who discussed their child's transition with providers, which could be contributing to the large percentage of CHD patients who do not successfully transfer to adult care. © 2017 Wiley

  1. Insurance access in adults with congenital heart disease in the Affordable Care Act era.

    Science.gov (United States)

    Lin, Chien-Jung; Novak, Eric; Rich, Michael W; Billadello, Joseph J

    2018-02-26

    Adults with congenital heart disease (ACHD) have traditionally been viewed as an underinsured population. Whether this is true in the Affordable Care Act era is unknown. We determined insurance patterns in ACHD patients compared to the non-ACHD cardiology population in a contemporary cohort. All cardiology outpatient visits between July 2016 and February 2017 to a large referral center in the United States were reviewed. The primary payer was categorized as health maintenance organization (HMO), preferred provider organization (PPO), Medicare, Medicaid, self-pay, or other. Diagnosis and lesion severity of ACHD were extracted from ICD-10 diagnostic codes and assigned according to the 2008 American College of Cardiology/American Heart Association ACHD guidelines. Age-matching was used to account for baseline age differences between ACHD and non-ACHD patients. E ACHD and 17 154 non-ACHD patients were identified. Without age-matching, ACHD patients were significantly younger than non-ACHD patients (mean age 38.5 vs 63.8 years). After age-matching (N = 805 in each group), mean age was 39.5 years in both groups. ACHD patients had less HMO (29.1% vs 34.7%, P = .012) and Medicaid (12.4% vs 17.3%, P = .006) coverage, but more PPO (34.4% vs 27.5%, P = .003) and Medicare (23.2% vs 18.1%, P = .005) coverage compared to non-ACHD patients. No differences were found in private insurance, public insurance, or self-pay. Lesion complexity had no effect on insurance in ACHD patients. Eligibility of parental plan coverage did not affect use of private insurance. ACHD patients in states with Medicaid expansion had higher rates of Medicaid (15.6% vs 10.6%, P = .045) but lower rates of HMO coverage (24.5% vs 31.7%, P = .036) and self-pay (0% vs 3.3%, P access to insurance. © 2018 Wiley Periodicals, Inc.

  2. Ask me what is in my heart of hearts! The core question of care in relation to parents who are patients in a psychiatric care context.

    Science.gov (United States)

    Blegen, Nina Elisabeth; Eriksson, Katie; Bondas, Terese

    2016-01-01

    The aim is to understand the experience of being cared for in psychiatric care as a patient and as a parent. Parenthood represents the natural form of human caring, a human directedness regardless of gender. The study has its starting point in this image, as it applies to mothers who receive care as provided in a psychiatric care context. The theoretical perspective is the theory of caritative caring, and the methodological approach is the philosophical hermeneutics outlined by Gadamer. The sample was purposeful: 10 mothers who experienced being a mother while suffering from mental illness and receiving care from professionals in psychiatric specialist health care contexts. The interpretation process is inductive, deductive, and abductive, and includes different levels of rational, contextual, existential, and ontological interpretation supported by the chosen theoretical perspective and the philosophy of ethics outlined by Emmanuel Levinas. The interpretation on the contextual level shows that the patients do not talk about their inner feelings concerning themselves as mothers in the care relationship. The interpretation on the existential level reveals the meaning of the mothers' experiences of inner struggle between their inner demands and assuming a mask of silence. The patients' experiences on the ontological level were interpreted as a struggle between the responsibility inherent in human being and the fear of condemnation. At the ontological level, a new hypothesis of the understanding of the meaning of the parents' experiences was formulated: Being in care as a patient and as a parent means struggling to restore one's responsibility as a human being. This new understanding paves the way for caring of the patient who is a parent.

  3. Ask me what is in my heart of hearts! The core question of care in relation to parents who are patients in a psychiatric care context

    Directory of Open Access Journals (Sweden)

    Nina Elisabeth Blegen

    2016-06-01

    Full Text Available The aim is to understand the experience of being cared for in psychiatric care as a patient and as a parent. Parenthood represents the natural form of human caring, a human directedness regardless of gender. The study has its starting point in this image, as it applies to mothers who receive care as provided in a psychiatric care context. The theoretical perspective is the theory of caritative caring, and the methodological approach is the philosophical hermeneutics outlined by Gadamer. The sample was purposeful: 10 mothers who experienced being a mother while suffering from mental illness and receiving care from professionals in psychiatric specialist health care contexts. The interpretation process is inductive, deductive, and abductive, and includes different levels of rational, contextual, existential, and ontological interpretation supported by the chosen theoretical perspective and the philosophy of ethics outlined by Emmanuel Levinas. The interpretation on the contextual level shows that the patients do not talk about their inner feelings concerning themselves as mothers in the care relationship. The interpretation on the existential level reveals the meaning of the mothers’ experiences of inner struggle between their inner demands and assuming a mask of silence. The patients’ experiences on the ontological level were interpreted as a struggle between the responsibility inherent in human being and the fear of condemnation. At the ontological level, a new hypothesis of the understanding of the meaning of the parents’ experiences was formulated: Being in care as a patient and as a parent means struggling to restore one's responsibility as a human being. This new understanding paves the way for caring of the patient who is a parent.

  4. Biomarkers of Myocardial Stress and Systemic Inflammation in Patients Who Engage in Heart Failure Self-Care Management

    Science.gov (United States)

    Lee, Christopher S.; Moser, Debra K.; Lennie, Terry A.; Tkacs, Nancy C.; Margulies, Kenneth B.; Riegel, Barbara

    2010-01-01

    Background Self-care is believed to improve heart failure (HF) outcomes, but the mechanisms by which such improvement occurs remain unclear. Methods We completed a secondary analysis of cross-sectional data collected on adults with symptomatic HF to test our hypothesis that effective self-care is associated with less myocardial stress and systemic inflammation. Multivariate logistic regression modeling was used to determine if better HF self-care reduced the odds of having serum levels of NT proBNP and soluble TNFα receptor type 1 at or above the sample median. HF self-care was measured using the Self-Care of Heart Failure Index. Results The sample (n=168) was predominantly male (65.5%) and most (50.6%) had NYHA III HF (mean LVEF= 34.9%±14.0%); mean age was 58.8±11.5 years. Self-care management was an independent factor in the model (block χ2 =14.74, p=.005) after controlling for pertinent confounders (model χ2 =52.15, pself-care management score (range 15–100) was associated with a 12.7% reduction in the odds of having both biomarkers at or above the sample median (adjusted odds ratio =0.873, 95% CI=0.77–0.99, p=.03). Conclusion Better self-care management was associated with reduced odds of myocardial stress and systemic inflammation over and above pharmacologic therapy and other common confounding factors. Teaching HF patients early symptom recognition and self-care of symptoms may decrease myocardial stress and systemic inflammation. PMID:21263344

  5. Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.

    Science.gov (United States)

    Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

    2013-08-01

    Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

  6. Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial.

    Science.gov (United States)

    Bekelman, David B; Allen, Larry A; McBryde, Connor F; Hattler, Brack; Fairclough, Diane L; Havranek, Edward P; Turvey, Carolyn; Meek, Paula M

    2018-04-01

    Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy. To determine whether a symptom and psychosocial collaborative care intervention improves heart failure-specific health status, depression, and symptom burden in patients with heart failure. A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015. Data from all participants were included regardless of level of participation, using an intent-to-treat approach. Patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with the patients' primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician. The primary outcome was patient-reported heart failure-specific health status, measured by difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range, 0-100) at 6 months. Secondary outcomes included depression (measured by the 9-item Patient Health Questionnaire), anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire), overall symptom distress (measured by the General Symptom Distress Scale), specific symptoms (pain, fatigue, and shortness of breath), number of hospitalizations, and mortality. Of 314 patients randomized (157 to intervention arm and 157 to control arm), there were 67 women and 247 men, mean (SD) age was 65.5 (11.4) years, and 178 (56.7%) had reduced ejection fraction. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm and 2.9 points in the control

  7. Attitudes among healthcare professionals towards ICT and home follow-up in chronic heart failure care.

    Science.gov (United States)

    Gund, Anna; Lindecrantz, Kaj; Schaufelberger, Maria; Patel, Harshida; Sjöqvist, Bengt Arne

    2012-11-28

    eHealth applications for out-of-hospital monitoring and treatment follow-up have been advocated for many years as a promising tool to improve treatment compliance, promote individualized care and obtain a person-centred care. Despite these benefits and a large number of promising projects, a major breakthrough in everyday care is generally still lacking. Inappropriate organization for eHealth technology, reluctance from users in the introduction of new working methods, and resistance to information and communication technology (ICT) in general could be reasons for this. Another reason may be attitudes towards the potential in out-of-hospital eHealth applications. It is therefore of interest to study the general opinions among healthcare professionals to ICT in healthcare, as well as the attitudes towards using ICT as a tool for patient monitoring and follow-up at home. One specific area of interest is in-home follow-up of elderly patients with chronic heart failure (CHF). The aim of this paper is to investigate the attitudes towards ICT, as well as distance monitoring and follow-up, among healthcare professionals working with this patient group. This paper covers an attitude survey study based on responses from 139 healthcare professionals working with CHF care in Swedish hospital departments, i.e. cardiology and medicine departments. Comparisons between physicians and nurses, and in some cases between genders, on attitudes towards ICT tools and follow-up at home were performed. Out of the 425 forms sent out, 139 were collected, and 17 out of 21 counties and regions were covered in the replies. Among the respondents, 66% were nurses, 30% physicians and 4% others. As for gender, 90% of nurses were female and 60% of physicians were male. Internet was used daily by 67% of the respondents. Attitudes towards healthcare ICT were found positive as 74% were positive concerning healthcare ICT today, 96% were positive regarding the future of healthcare ICT, and 54% had high

  8. Youth Unemployment in the Caribbean

    OpenAIRE

    Monica Parra-Torrado

    2014-01-01

    Global economic shocks coupled with natural disasters left most Caribbean countries with zero to negative growth and high unemployment rates. The Caribbean region was strongly affected by the last great financial crisis, which resulted in a regional average of zero economic growth in 2010. The purpose of this note is to evaluate the nature of youth unemployment in order to propose policy o...

  9. Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Callender, Thomas; Woodward, Mark; Roth, Gregory; Farzadfar, Farshad; Lemarie, Jean-Christophe; Gicquel, Stéphanie; Atherton, John; Rahimzadeh, Shadi; Ghaziani, Mehdi; Shaikh, Maaz; Bennett, Derrick; Patel, Anushka; Lam, Carolyn S. P.; Sliwa, Karen; Barretto, Antonio; Siswanto, Bambang Budi; Diaz, Alejandro; Herpin, Daniel; Krum, Henry; Eliasz, Thomas; Forbes, Anna; Kiszely, Alastair; Khosla, Rajit; Petrinic, Tatjana; Praveen, Devarsetty; Shrivastava, Roohi; Xin, Du; MacMahon, Stephen; McMurray, John; Rahimi, Kazem

    2014-01-01

    Background Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs. Methods and Findings Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, pheart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%–64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%–41%) with beta-blockers, and 32% (95% CI: 25%–39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%–7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%–10%). There was substantial variation between studies (pheart failure was identified. Conclusions The presentation, underlying causes, management, and outcomes of heart

  10. Physical and digital proximity: emerging ways of health care in face-to-face and telemonitoring of heart-failure patients

    NARCIS (Netherlands)

    Oudshoorn, Nelly E.J.

    2009-01-01

    The introduction of telehealth-care technologies profoundly changes existing practices of care. This paper aims to enhance our understanding of these changes by providing a comparative study of health-care services for heart-failure patients based on face-to-face contacts in a policlinic (department

  11. Problems in the organization of care for patients with adult congenital heart disease

    NARCIS (Netherlands)

    Meijboom, Folkert; Mulder, Barbara

    2010-01-01

    The prevalence of congenital heart disease among adults in Europe, or in any country in Europe, is not known. This is due to a lack of agreement on the incidence of congenital heart disease, with estimations varying from four per 1000 births to 50 per 1000 births, and it is not known how many

  12. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo).

    Science.gov (United States)

    Ciccone, Marco Matteo; Aquilino, Ambrogio; Cortese, Francesca; Scicchitano, Pietro; Sassara, Marco; Mola, Ernesto; Rollo, Rodolfo; Caldarola, Pasquale; Giorgino, Francesco; Pomo, Vincenzo; Bux, Francesco

    2010-05-06

    Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM) model and of the introduction of "care manager" nurses, trained in this specialized role, into the primary health care system. Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative "team" consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD), diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk) to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization. Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home. Physicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong "partnership" between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in

  13. Comparison the effect of Quran and lullaby on heart rate changes of hospitalized neonates in Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Taheri L

    2015-08-01

    Full Text Available Background and Objective: Maintain a normal heart rate in newborns in intensive care unit is an important goal in neonatal care. Non-pharmaceutical interventions in this area are important. The current study was conducted aimed to determine the effect of Quran and lullaby on heart rate changes of hospitalized neonates in NICU.  Materials and Method: The current clinical trial study was done on 78 hospitalized newborns in neonatal intensive care unit in one of the hospitals in Jahrom in 2013-2014. Newborns were selected through convenience sampling and then were randomly allocated to three groups, Quran, Lullaby and control groups. The newborne in two intervention groups listened to lullaby or Quran via headphones during 3 days and daily for 20 minutes and in control group, headphone was laid without voice for newborns. The heart rate of newborns was recorded immediately before the interventuion, 10 and 20 minutes after the starting the intervention and finally 20 minutes after the completion of it. Data were analyzed through SPSS 19 using Greenhouse - Geisser test, ANOVA and repeated measures ANOVA.  Results: The mean of heart rate of neonates in lullaby group, Quran and control groups before the intervention was respectively 135.7 ± 6.15, 140.56 ± 14.97 and 132.21 ± 25.21 that the difference between them was not statistically significant, but the mean change of their heart rate was significantly lower in twentieth minute in the second day in lullaby group (126.67 ± 11.22 in compare with control group (134.31±18.31 and Quran group (138.81 ± 19.12 (P = 0.016.  Conclusion: With attention to the effect of lullaby in the second day on decreas the heart rate changes, this method can be used in the neonatal intensive care unit. Also, according to the healing effects of Quran, more research in this area is recommended.

  14. Caribbean Sea Level Network

    Science.gov (United States)

    von Hillebrandt-Andrade, C.; Crespo Jones, H.

    2012-12-01

    Over the past 500 years almost 100 tsunamis have been observed in the Caribbean and Western Atlantic, with at least 3510 people having lost their lives to this hazard since 1842. Furthermore, with the dramatic increase in population and infrastructure along the Caribbean coasts, today, millions of coastal residents, workers and visitors are vulnerable to tsunamis. The UNESCO IOC Intergovernmental Coordination Group for Tsunamis and other Coastal Hazards for the Caribbean and Adjacent Regions (CARIBE EWS) was established in 2005 to coordinate and advance the regional tsunami warning system. The CARIBE EWS focuses on four areas/working groups: (1) Monitoring and Warning, (2) Hazard and Risk Assessment, (3) Communication and (4) Education, Preparedness and Readiness. The sea level monitoring component is under Working Group 1. Although in the current system, it's the seismic data and information that generate the initial tsunami bulletins, it is the data from deep ocean buoys (DARTS) and the coastal sea level gauges that are critical for the actual detection and forecasting of tsunamis impact. Despite multiple efforts and investments in the installation of sea level stations in the region, in 2004 there were only a handful of sea level stations operational in the region (Puerto Rico, US Virgin Islands, Bermuda, Bahamas). Over the past 5 years there has been a steady increase in the number of stations operating in the Caribbean region. As of mid 2012 there were 7 DARTS and 37 coastal gauges with additional ones being installed or funded. In order to reach the goal of 100 operational coastal sea level stations in the Caribbean, the CARIBE EWS recognizes also the importance of maintaining the current stations. For this, a trained workforce in the region for the installation, operation and data analysis and quality control is considered to be critical. Since 2008, three training courses have been offered to the sea level station operators and data analysts. Other

  15. The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal.

    Science.gov (United States)

    Lobo, Mariana F; Azzone, Vanessa; Resnic, Frederic S; Melica, Bruno; Teixeira-Pinto, Armando; Azevedo, Luís Filipe; Freitas, Alberto; Nisa, Cláudia; Bacelar-Nicolau, Leonor; Rocha-Gonçalves, Francisco Nuno; Pereira-Miguel, José; Costa-Pereira, Altamiro; Normand, Sharon-Lise

    2017-09-01

    We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. The effect of education through motivational interviewing compared with conventional education on self-care behaviors in heart failure patients with depression.

    Science.gov (United States)

    Navidian, Ali; Mobaraki, Hajar; Shakiba, Mansour

    2017-08-01

    To determine the effect of education based on motivational interviewing on self-care behaviors in heart failure patients with depression. In this study, 82 patients suffering from heart failure whose depression had been confirmed were selected and divided into two groups. The Self-Care Heart Failure Index was utilized to evaluate self-care behavior. The intervention group received four sessions of self-care behavior education based on the principles of motivational interviewing, and the control group received four sessions of conventional education on self-care behavior. At 8 weeks after finishing the interventions, the self-care behaviors of both groups were evaluated. Data were analyzed using paired and independent t-tests, Chi-square, and analysis of covariance, as appropriate. The average increase in the overall scores and the scores on the three sub-scales of self-care behavior (maintenance, management, and confidence) of the heart failure patients with depression were significantly higher after education based on motivational interviewing than after conventional self-care education (pMotivational interviewing had a significant positive effect on self-care behaviors in patients with heart failure and depression. Due to the effectiveness of the MI, using motivational interviewing for education in depressed HF patients is recommended. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Heart transplant

    Science.gov (United States)

    ... hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in ... follow your self-care instructions. Biopsies of the heart muscle are ... after transplant, and then less often after that. This helps ...

  18. The care of adults with congenital heart disease across the globe : Current assessment and future perspective A position statement from the International Society for Adult Congenital Heart Disease (ISACHD)

    NARCIS (Netherlands)

    Webb, Gary; Mulder, Barbara J.; Aboulhosn, Jamil; Daniels, Curt J.; Elizari, Maria Amalia; Hong, Gu; Horlick, Eric; Landzberg, Michael J.; Marelli, Ariane J.; O'Donnell, Clare P.; Oechslin, Erwin N.; Pearson, Dorothy D.; Pieper, Els P. G.; Saxena, Anita; Schwerzmann, Markus; Stout, Karen K.; Warnes, Carole A.; Khairy, Paul

    2015-01-01

    The number of adults with congenital heart disease (CHD) has increased markedly over the past few decades as a result of astounding successes in pediatric cardiac care. Nevertheless, it is now well understood that CHD is not cured but palliated, such that life-long expert care is required to

  19. [The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].

    Science.gov (United States)

    Ruescas-Escolano, Esther; Orozco-Beltran, Domingo; Gaubert-Tortosa, María; Navarro-Palazón, Ana; Cordero-Fort, Alberto; Navarro-Pérez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Núñez-Martínez, Miguel A; Bertomeu-Martínez, Vicente; López-Pineda, Adriana; Gil-Guillén, Vicente F

    2014-06-01

    Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  20. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data.

    Science.gov (United States)

    Rasella, Davide; Harhay, Michael O; Pamponet, Marina L; Aquino, Rosana; Barreto, Mauricio L

    2014-07-03

    To evaluate the impact of Brazil's recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009. Ecological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications. Nationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009. 1622 Brazilian municipalities with vital statistics of adequate quality. The annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period. FHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results. Comprehensive and community based primary

  1. Health Literacy Influences Heart Failure Knowledge Attainment but Not Self-Efficacy for Self-Care or Adherence to Self-Care over Time

    Directory of Open Access Journals (Sweden)

    Aleda M. H. Chen

    2013-01-01

    Full Text Available Background. Inadequate health literacy may be a barrier to gaining knowledge about heart failure (HF self-care expectations, strengthening self-efficacy for self-care behaviors, and adhering to self-care behaviors over time. Objective. To examine if health literacy is associated with HF knowledge, self-efficacy, and self-care adherence longitudinally. Methods. Prior to education, newly referred patients at three HF clinics (N=51, age: 64.7±13.0 years completed assessments of health literacy, HF knowledge, self-efficacy, and adherence to self-care at baseline, 2, and 4 months. Repeated measures analysis of variance with Bonferroni-adjusted alpha levels was used to test longitudinal outcomes. Results. Health literacy was associated with HF knowledge longitudinally (P<0.001 but was not associated with self-efficacy self-care adherence. In posthoc analyses, participants with inadequate health literacy had less HF knowledge than participants with adequate (P<0.001 but not marginal (P=0.073 health literacy. Conclusions. Adequate health literacy was associated with greater HF knowledge but not self-efficacy or adherence to self-care expectations over time. If nurses understand patients’ health literacy level, they may educate patients using methods that promote understanding of concepts. Since interventions that promote self-efficacy and adherence to self-care were not associated with health literacy level, new approaches must be examined.

  2. The key role of caregiver confidence in the caregiver's contribution to self-care in adults with heart failure.

    Science.gov (United States)

    Vellone, Ercole; D'Agostino, Fabio; Buck, Harleah G; Fida, Roberta; Spatola, Carlo F; Petruzzo, Antonio; Alvaro, Rosaria; Riegel, Barbara

    2015-10-01

    Caregivers play an important role in contributing to heart failure (HF) patients' self-care but no prior studies have examined the caregivers' contributions to HF patients' self-care and no prior studies have examined potential determinants of the caregivers' contribution to HF patients' self-care. The purpose of this study was to describe the caregivers' contribution to HF patients' self-care and identify its determinants. The study design involved a secondary analysis of cross-sectional data. Caregivers' contributions were measured with the Caregiver's Contribution to Self-care of HF Index (CC-SCHFI) which measures the caregiver's contribution to self-care maintenance and management and caregiver confidence in contributing to HF patient's self-care. Potential determinants were measured using a socio-demographic questionnaire completed by caregivers and patients, and patient clinical data was obtained from the medical record. Data from 515 caregiver/patient dyads were analyzed. Most (55.5%) patients were male (mean age 75.6 years) and most (52.4%) caregivers were female (mean age, 56.6 years). The caregivers' contribution to patients' self-care maintenance was low in weight monitoring and physical activity but higher in checking ankles, advising on low-salt foods and taking medicines. The caregivers' contribution to patients' self-care management was low in symptom recognition. When symptoms were recognized, caregivers advised patients to reduce fluids and salt and call the provider but rarely advised to take an extra diuretic. Caregiver confidence in the ability to contribute to patient self-care explained a significant amount of variance in the caregiver's contribution. These findings suggest that caregivers in this sample did not contribute meaningfully to HF self-care. Providers should educate both HF patients and caregivers. Interventions that improve caregiver confidence have the potential to successfully increase the caregivers' contribution to patients

  3. [Efficacy of a multidisciplinary care management program for patients admitted at hospital because of heart failure (ProMIC)].

    Science.gov (United States)

    Domingo, Cristina; Aros, Fernando; Otxandategi, Agurtzane; Beistegui, Idoia; Besga, Ariadna; Latorre, Pedro María

    2018-02-26

    To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate. Quasi-experimental research with control group. Twelve primary health care centres and 3 hospitals from the Basque Country. Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV. Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care. The rate of readmission for HF and health-related quality of life RESULTS: One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio=0.59, CI 95%: 0.36-0.98; P=.049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up. ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables. Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.......To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF....

  5. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: A Randomized Clinical Trial

    Science.gov (United States)

    Freedland, Kenneth E.; Carney, Robert M.; Rich, Michael W.; Steinmeyer, Brian C.; Rubin, Eugene H.

    2016-01-01

    Importance Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF). Objective To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care. Design, Setting, and Participants Randomized clinical trial with single-blind outcome assessments. Eligible patients were enrolled at Washington University Medical Center in St. Louis between January 4, 2010 and June 28, 2013. The participants were 158 outpatients in New York Heart Association Class I, II, and III heart failure with comorbid major depression. Interventions Cognitive behavior therapy delivered by experienced therapists plus usual care (UC), or usual care alone. Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse. Main Outcomes and Measures The primary outcome was severity of depression at 6 months as measured by the Beck Depression Inventory. The Self-Care of Heart Failure Index Confidence and Maintenance subscales were co-primary outcomes. Secondary outcomes included measures of anxiety, depression, physical functioning, fatigue, social roles and activities, and quality of life. Hospitalizations and deaths were exploratory outcomes. Results One hundred fifty-eight patients were randomized to UC (n=79) or CBT (n=79). Within each arm, 26 (33%) of the patients were taking an antidepressant at baseline. One hundred thirty-two (84%) of the participants completed the 6-month posttreatment assessments; 60 (76%) of the UC and 58 (73%) of the CBT participants completed every follow-up assessment (P−.88). Six-month depression scores were lower in the CBT than the UC arm on the Beck Depression Inventory (BDI-II) (12.8 [10.6] vs 17.3 [10.7]; P−.008). Remission rates differed on the BDI-II (46% vs 19%; number needed to treat [NNT] = 3.76; 95% CI, 3.62-3.90; PSelf-Care Maintenance or Confidence

  6. Outcomes of an Interdisciplinary Transitional Care Quality Improvement Project on Self-Management and Health Care Use in Patients With Heart Failure.

    Science.gov (United States)

    Hoover, Carrie; Plamann, Joy; Beckel, Jean

    2017-01-01

    Heart failure (HF) accounts for most U.S. Medicare hospital admissions. The purpose of the current study was to evaluate the effectiveness of a care transitions quality improvement (QI) intervention on self-management and readmission rates in older adults with HF. A quasi-experimental, descriptive study was conducted with 66 patients with HF in three medical units in a 489-bed Midwestern acute care hospital. The intervention included a nurse coach visit and follow up, pharmacy medication education and reconciliation, and HF clinic referral. Outcomes were assessed within 48 hours of admission and 30 days after discharge using the Self-Care of Heart Failure Index and medical record review. Following implementation, readmission rates decreased from 24% to 13%. Participants demonstrated a greater improvement in use of self-management strategies to control symptoms than the non-intervention group (p < 0.02) and more readily identified their symptoms of HF (p < 0.04). The evolution of population health, with increasing numbers of older adults living at home with complex chronic conditions, will require establishment of active partnerships among pharmacists, physicians, nurse specialists, home care nurses, and patients. [Journal of Gerontological Nursing, 43(1), 23-31.]. Copyright 2016, SLACK Incorporated.

  7. Application of the health belief model in promotion of self-care in heart failure patients.

    Science.gov (United States)

    Baghianimoghadam, Mohammad Hosein; Shogafard, Golamreza; Sanati, Hamid Reza; Baghianimoghadam, Behnam; Mazloomy, Seyed Saeed; Askarshahi, Mohsen

    2013-01-01

    Heart failure (HF) is a condition due to a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. In developing countries, around 2% of adults suffer from heart failure, but in people over the age of 65, this rate increases to 6-10%. In Iran, around 3.3% of adults suffer from heart failure. The Health Belief Model (HBM) is one of the most widely used models in public health theoretical framework. This was a cohort experimental study, in which education as intervention factor was presented to case group. 180 Heart failure patients were randomly selected from patients who were referred to the Shahid Rajaee center of Heart Research in Tehran and allocated to two groups (90 patients in the case group and 90 in the control group). HBM was used to compare health behaviors. The questionnaire included 69 questions. All data were collected before and 2 months after intervention. About 38% of participants don't know what, the heart failure is and 43% don't know that using the salt is not suitable for them. More than 40% of participants didn't weigh any time their selves. There was significant differences between the mean grades score of variables (perceived susceptibility, perceived threat, knowledge, Perceived benefits, Perceived severity, self-efficacy Perceived barriers, cues to action, self- behavior) in the case and control groups after intervention that was not significant before it. Based on our study and also many other studies, HBM has the potential to be used as a tool to establish educational programs for individuals and communities. Therefore, this model can be used effectively to prevent different diseases and their complications including heart failure. © 2013 Tehran University of Medical Sciences. All rights reserved.

  8. Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care

    Science.gov (United States)

    Coupland, Carol

    2016-01-01

    Objective To assess associations between risks of cardiovascular disease, heart failure, and all cause mortality and different diabetes drugs in people with type 2 diabetes, particularly newer agents, including gliptins and thiazolidinediones (glitazones). Design Open cohort study. Setting 1243 general practices contributing data to the QResearch database in England. Participants 469 688 people with type 2 diabetes aged 25-84 years between 1 April 2007 and 31 January 2015. Exposures Diabetes drugs (glitazones, gliptins, metformin, sulphonylureas, insulin, other) alone and in combination. Main outcome measure First recorded diagnoses of cardiovascular disease, heart failure, and all cause mortality recorded on the patients’ primary care, mortality, or hospital record. Cox proportional hazards models were used to estimate hazard ratios for diabetes treatments, adjusting for potential confounders. Results During follow-up, 21 308 patients (4.5%) received prescriptions for glitazones and 32 533 (6.9%) received prescriptions for gliptins. Compared with non-use, gliptins were significantly associated with an 18% decreased risk of all cause mortality, a 14% decreased risk of heart failure, and no significant change in risk of cardiovascular disease; corresponding values for glitazones were significantly decreased risks of 23% for all cause mortality, 26% for heart failure, and 25% for cardiovascular disease. Compared with no current treatment, there were no significant associations between monotherapy with gliptins and risk of any complications. Dual treatment with gliptins and metformin was associated with a decreased risk of all three outcomes (reductions of 38% for heart failure, 33% for cardiovascular disease, and 48% for all cause mortality). Triple treatment with metformin, sulphonylureas, and gliptins was associated with a decreased risk of all three outcomes (reductions of 40% for heart failure, 30% for cardiovascular disease, and 51% for all cause

  9. Health Status and Self-care Outcomes Following an Education-Support Intervention for People with Chronic Heart Failure

    Science.gov (United States)

    Clark, Angela P.; McDougall, Graham; Riegel, Barbara; Joiner-Rogers, Glenda; Innerarity, Sheri; Meraviglia, Martha; Delville, Carol; Davila, Ashley

    2014-01-01

    Background The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. Objective The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I-III HF. Our secondary purpose was to explore participants’ subjective perceptions of the intervention. Methods This study used a randomized, 2 group design. Fifty people were enrolled for 9 months and tested at 4 time points—baseline; following a 3-month education-support intervention; at 6 months, following 3-months of telephone/email support; and 9 months, following a 3-month period of no contact. Advanced practice registered nurses (APRNs) delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention’s effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. Results The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%), and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy and quality of life (Kansas City Cardiomyopathy Questionnaire-KCCQ); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire-MIA); self-care knowledge (HF Knowledge Test-HFKT); and self-care (Self-Care in Heart Failure Index—SCHFI). Participants in both

  10. Review of HIV treatment progress, gaps, and challenges in the Caribbean, 2005-2015.

    Science.gov (United States)

    Gebre, Yitades; Forbes, Nikkiah Meoshi; Peters, Abena

    2016-12-01

    To highlight the current context of the HIV response in the Caribbean and what remains to be addressed to close gaps in HIV treatment and care and end AIDS by 2030. We reviewed and analyzed reports from peer-reviewed and gray literature for the period of 2005-2015 on HIV treatment progress and gaps in the Caribbean, based on searches done in four bibliographic databases and three organizations' websites and/or libraries. Data were extracted using forms detailing study objectives, thematic areas for HIV care and treatment in the Caribbean, results, and other key information. Before being included in the descriptive review, each publication was assessed for its relevance to the HIV response in the Caribbean. We carefully analyzed a total of 62 sources addressing HIV treatment coverage in the Caribbean, including peer-reviewed articles, gray literature reports, and abstracts. The Caribbean has made remarkable progress in reducing new infections and in increasing health care access. Coverage with antiretroviral (ARV) treatment rose between 2005 and 2015, and HIV-related mortality fell by half. Despite the decline in HIV incidence rates, some Caribbean countries have reported challenges with linkages to care, access and adherence to ARV treatment, and viral suppression. The risk of HIV infection in the Caribbean among at-risk populations, including men who have sex with men, transgender persons, and sex workers, is disproportionately high. Caribbean countries need to work together to face the HIV threat. National programs need to fast-track HIV treatment services and accelerate other responses to HIV by 2020, and then maintain sustained actions up through 2030.

  11. Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach.

    Science.gov (United States)

    Holden, Richard J; Schubert, Christiane C; Eiland, Eugene C; Storrow, Alan B; Miller, Karen F; Collins, Sean P

    2015-07-01

    We pilot tested a sociotechnical systems-based instrument that assesses the prevalence and nature of self-care barriers among patients presenting to the emergency department (ED) with acute heart failure. A semistructured instrument for measuring self-reported self-care barriers was developed and administered by ED clinicians and nonclinician researchers to 31 ED patients receiving a diagnosis of acute heart failure. Responses were analyzed with descriptive statistics and qualitative content analysis. Feasibility was assessed by examining participant cooperation rates, instrument completion times, item nonresponse, and data yield. Of 47 distinct self-care barriers assessed, a median of 15 per patient were indicated as "sometimes" or "often" present. Thirty-four specific barriers were reported by more than 25% of patients and 9 were reported by more than 50%. The sources of barriers included the person, self-care tasks, tools and technologies, and organizational, social, and physical contexts. Seven of the top 10 most prevalent barriers were related to patient characteristics; the next 3, to the organizational context (eg, life disruptions). A preliminary feasibility assessment found few item nonresponses or comprehension difficulties, good cooperation, and high data yield from both closed- and open-ended items, but also found opportunities to reduce median administration time and variability. An instrument assessing self-care barriers from multiple system sources can be feasibly implemented in the ED. Further research is required to modify the instrument for widespread use and evaluate its implementation across institutions and cultural contexts. Self-care barriers measurement can be one component of broader inquiry into the distributed health-related "work" activity of patients, caregivers, and clinicians. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  12. Medical tourism in the Caribbean.

    Science.gov (United States)

    Ramírez de Arellano, Annette B

    2011-01-01

    Although travel for medical reasons has a long history, it has more recently evolved from a cottage industry to a worldwide enterprise. A number of countries are positioning themselves to attract visitors who are willing to travel to obtain health services that are more accessible, less expensive, or more available than in their countries of origin. This has in turn given rise to medical packages that combine tourism with health. Several Caribbean nations - including Cuba, Barbados, Jamaica, and Puerto Rico - hope to expand their revenues in this new market. Each country has selected specific service niches and promotes its services accordingly. While Cuba has been promoting its services to other countries for several decades, medical tourism is just beginning in the other islands. Ultimately, these nations' economic success will hinge on their comparative advantage vis-à-vis other options, while their success in terms of improving their own health care depends on the extent to which the services for tourists are also available to the islands' populations.

  13. Prescribing in general practice for people with coronary heart disease; equity by age, sex, ethnic group and deprivation.

    Science.gov (United States)

    Mathur, Rohini; Badrick, Ellena; Boomla, Kambiz; Bremner, Stephen; Hull, Sally; Robson, John

    2011-04-01

    Differences in drug prescribing for coronary heart disease have previously been identified by age, sex and ethnic group. Set in the UK, our study utilises routinely collected data from 98 general practices serving a socially diverse population in inner East London, to examine differences in prescribing rates among patients aged 35 years and over with coronary heart disease. 10,933 patients aged 35 years or more, with recorded coronary heart disease, from 98 practices in two Primary Care Trusts (PCT) in East London during 2009/2010 were included for this cross-sectional study. Multivariable logistic regression was used to assess the odds of prescribing for recommended coronary heart disease drugs by age, sex, ethnicity, social deprivation, co-morbidity and recorded reasons for not prescribing. Women are prescribed fewer recommended coronary heart disease drugs than men; Black African/Caribbean patients are prescribed fewer lipid modifying drugs and other cardiovascular drugs than White patients. Patients over age 84 are prescribed fewer lipid modifying drugs and beta blockers than patients aged 45-54. South Asian patients had the highest levels of prescribing and higher prevalence of coronary heart disease and diabetes co-morbidity. No difference in prescribing rates by social deprivation was found. Overall levels of prescribing are high but small differences between sex and ethnic groups remain and prescribing may be inequitable for women, for Black/African Caribbeans and at older ages. These differences were not explained by recorded intolerance, contraindications or declining treatment.

  14. Structured chronic primary care and health-related quality of life in chronic heart failure.

    NARCIS (Netherlands)

    Bosch, M.C.; Weijden, G.D.E.M. van der; Grol, R.P.T.M.; Schers, H.J.; Akkermans, R.P.; Niessen, L.; Wensing, M.J.P.

    2009-01-01

    BACKGROUND: Structured care is proposed as a lever for improving care for patients with chronic conditions. The purpose of this study was to explore the associations of structured care characteristics, derived from the Chronic Care Model, with health-related quality of life (HRQOL) and optimal

  15. Guideline compliance in chronic heart failure patients with multiple comorbid diseases: evaluation of an individualised multidisciplinary model of care.

    Directory of Open Access Journals (Sweden)

    Tam H Ho

    Full Text Available OBJECTIVE: To assess the impact of individualised, reconciled evidence-based recommendations (IRERs and multidisciplinary care in patients with chronic heart failure (CHF on clinical guideline compliance for CHF and common comorbid conditions. DESIGN AND SETTING: A retrospective hospital clinical audit conducted between 1st July 2006 and February 2011. PARTICIPANTS: A total of 255 patients with a diagnosis of CHF who attended the Multidisciplinary Ambulatory Consulting Services (MACS clinics, at the Royal Adelaide Hospital, were included. MAIN OUTCOME MEASURES: Compliance with Australian clinical guideline recommendations for CHF, atrial fibrillation, diabetes mellitus and ischaemic heart disease. RESULTS: Study participants had a median of eight medical conditions (IQR 6-10 and were on an average of 10 (±4 unique medications. Compliance with clinical guideline recommendations for pharmacological therapy for CHF, comorbid atrial fibrillation, diabetes or ischaemic heart disease was high, ranging from 86% for lipid lowering therapy to 98% anti-platelet agents. For all conditions, compliance with lifestyle recommendations was lower than pharmacological therapy, ranging from no podiatry reviews for CHF patients with comorbid diabetes to 75% for heart failure education. Concordance with many guideline recommendations was significantly associated if the patient had IRERs determined, a greater number of recommendations, more clinic visits or if patients participated in a heart failure program. CONCLUSIONS: Despite the high number of comorbid conditions and resulting complexity of the management, high compliance to clinical guideline recommendations was associated with IRER determination in older patients with CHF. Importantly these recommendations need to be communicated to the patient's general practitioner, regularly monitored and adjusted at clinic visits.

  16. 'Engage me in taking care of my heart': a grounded theory study on patient-cardiologist relationship in the hospital management of heart failure.

    Science.gov (United States)

    Barello, Serena; Graffigna, Guendalina; Vegni, Elena; Savarese, Mariarosaria; Lombardi, Federico; Bosio, A Claudio

    2015-03-16

    In approaching the study and practice of heart failure (HF) management, authors recognise that the patient-doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters. Using a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles. All interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy. The data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist. The HF patient engagement process develops in four main phases that are characterised by different patients' emotional, cognitive and behavioural dynamics that contribute to shape the process of a patient's meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients' ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients' engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience. This study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The model emerging from this study may help clinicians think in a fresh

  17. Outpatient Palliative Cardiology Service Embedded Within a Heart Failure Clinic: Experiences With an Emerging Model of Care.

    Science.gov (United States)

    Gandesbery, Benjamin; Dobbie, Krista; Gorodeski, Eiran Z

    2018-04-01

    The role of palliative care consultation in the outpatient treatment of patients with symptomatic heart failure (HF) is poorly studied. In August 2015, we created an outpatient palliative care service embedded within the HF clinic at Cleveland Clinic main campus. To characterize patients cared for by our novel outpatient palliative cardiology service, including their degree of HF, symptoms, comorbidities, topics addressed in clinic, palliative treatments prescribed, advanced directives status, and mortality. We conducted a retrospective chart review of all patients evaluated by this outpatient service. Eighty patients were seen in 229 outpatient encounters. The most commonly reported symptoms were tiredness (74%), pain (64%), dyspnea (57%), drowsiness (45%), anxiety (45%), and depression (43%). The most frequently addressed issues were pain management (55%) and advanced care planning (54%). The most common palliative medications prescribed in palliative care clinic were opiates (48%), laxatives (22%), antineuropathics (22%), and antidepressants (16%). The 1-year survival rate was 70% (CI 65-75%). Embedding palliative medicine services in an HF outpatient clinic is feasible. Patients seen in this setting had an array of quality-of-life limiting symptoms and were medically managed with several interventions familiar to palliative medicine specialists. Outpatients with chronic HF have a significant symptom burden and may benefit from outpatient specialist palliative care.

  18. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: A Randomized Clinical Trial.

    Science.gov (United States)

    Freedland, Kenneth E; Carney, Robert M; Rich, Michael W; Steinmeyer, Brian C; Rubin, Eugene H

    2015-11-01

    Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF). To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care. Randomized clinical trial with single-blind outcome assessments. Eligible patients were enrolled at Washington University Medical Center in St Louis between January 4, 2010, and June 28, 2013. The primary data analyses were conducted in February 2015. The participants were 158 outpatients in New York Heart Association Class I, II, and III heart failure with comorbid major depression. Cognitive behavior therapy delivered by experienced therapists plus usual care (UC), or UC alone. Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse. The primary outcome was severity of depression at 6 months as measured by the Beck Depression Inventory. The Self-Care of Heart Failure Index Confidence and Maintenance subscales were coprimary outcomes. Secondary outcomes included measures of anxiety, depression, physical functioning, fatigue, social roles and activities, and quality of life. Hospitalizations and deaths were exploratory outcomes. One hundred fifty-eight patients were randomized to UC (n = 79) or CBT (n = 79). Within each arm, 26 (33%) of the patients were taking an antidepressant at baseline. One hundred thirty-two (84%) of the participants completed the 6-month posttreatment assessments; 60 (76%) of the UC and 58 (73%) of the CBT participants completed every follow-up assessment (P = .88). Six-month depression scores were lower in the CBT than the UC arm on the Beck Depression Inventory (BDI-II) (12.8 [10.6] vs 17.3 [10.7]; P = .008). Remission rates differed on the BDI-II (46% vs 19%; number needed to treat [NNT] = 3.76; 95% CI, 3.62-3.90; P Beck Depression Inventory scores 6 months after randomization were lower in the CBT

  19. Type D personality is a predictor of poor emotional quality of life in primary care heart failure patients independent of depressive symptoms and New York Heart Association functional class.

    Science.gov (United States)

    Pedersen, Susanne S; Herrmann-Lingen, Christoph; de Jonge, Peter; Scherer, Martin

    2010-02-01

    Quality of life is an important patient-centered outcome and predictor of mortality in heart failure, but little is known about the role of personality as a determinant of quality of life in this patient group. We examined the influence of Type D personality (i.e., increased negative emotions paired with emotional non-expression) on quality of life in primary care heart failure patients, using a prospective study design. Heart failure patients (n = 251) recruited from 44 primary care practices in Germany completed standardized questionnaires at baseline and 9 months. The prevalence of Type D was 31.9%. Type D patients experienced poorer emotional (P emotional (P = .78) nor physical quality of life (P = .74) over time; neither the interaction for time by Type D for emotional (P = .31) nor physical quality of life (P = .91) was significant, indicating that Type D exerted a stable effect on quality of life over time. Adjusting for demographics, New York Heart Association functional class, and depressive symptoms, Type D remained an independent determinant of emotional (P = .03) but not physical quality of life (P = .29). Primary care heart failure patients with a Type D personality experienced poorer emotional but not physical quality of life compared to non-Type D patients. Patients with this personality profile should be identified in primary care to see if their treatment is optimal, as both Type D and poor quality of life have been associated with increased morbidity and mortality.

  20. Satellite Teleconferencing in the Caribbean.

    Science.gov (United States)

    Sankar, Hollis C.

    1985-01-01

    Discusses the need for, and the development, use, and future trends of, the University of the West Indies Distance Teaching Experiment, which utilizes telephone and communications satellite technology teleconferencing to extend educational opportunities to the peoples of the Caribbean. (MBR)

  1. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo

    Directory of Open Access Journals (Sweden)

    Marco Matteo Ciccone

    2010-04-01

    Full Text Available Marco Matteo Ciccone1, Ambrogio Aquilino2, Francesca Cortese1, Pietro Scicchitano1, Marco Sassara1, Ernesto Mola3, Rodolfo Rollo4,Pasquale Caldarola5, Francesco Giorgino6, Vincenzo Pomo2, Francesco Bux21Section of Cardiovascular Disease, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, Italy; 2Agenzia Regionale Sanitaria – Regione Puglia (ARES, Apulia, Italy; 3ASL, Lecce, Italy; 4ASL, Brindisi, Italy; 5Cardiologia, Ospedale “Sarcone”, Terlizzi, Italy; 6Section of Endocrinology, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, ItalyPurpose: Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM model and of the introduction of “care manager” nurses, trained in this specialized role, into the primary health care system. Patients and methods: Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative “team” consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD, diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization.Results: Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services

  2. The Caregiver Contribution to Heart Failure Self-Care (CACHS): Further Psychometric Testing of a Novel Instrument.

    Science.gov (United States)

    Buck, Harleah G; Harkness, Karen; Ali, Muhammad Usman; Carroll, Sandra L; Kryworuchko, Jennifer; McGillion, Michael

    2017-04-01

    Caregivers (CGs) contribute important assistance with heart failure (HF) self-care, including daily maintenance, symptom monitoring, and management. Until CGs' contributions to self-care can be quantified, it is impossible to characterize it, account for its impact on patient outcomes, or perform meaningful cost analyses. The purpose of this study was to conduct psychometric testing and item reduction on the recently developed 34-item Caregiver Contribution to Heart Failure Self-care (CACHS) instrument using classical and item response theory methods. Fifty CGs (mean age 63 years ±12.84; 70% female) recruited from a HF clinic completed the CACHS in 2014 and results evaluated using classical test theory and item response theory. Items would be deleted for low (.95) endorsement, low (.7) corrected item-total correlations, significant pairwise correlation coefficients, floor or ceiling effects, relatively low latent trait and item information function levels ( .5), and differential item functioning. After analysis, 14 items were excluded, resulting in a 20-item instrument (self-care maintenance eight items; monitoring seven items; and management five items). Most items demonstrated moderate to high discrimination (median 2.13, minimum .77, maximum 5.05), and appropriate item difficulty (-2.7 to 1.4). Internal consistency reliability was excellent (Cronbach α = .94, average inter-item correlation = .41) with no ceiling effects. The newly developed 20-item version of the CACHS is supported by rigorous instrument development and represents a novel instrument to measure CGs' contribution to HF self-care. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  3. The EuroHeart Failure Survey programme - a survey on the quality of care among patients with heart failure in Europe Part 2 : treatment

    NARCIS (Netherlands)

    Komajda, M; Swedberg, K; Cleland, J; Aguilar, JC; Cohen-Solal, A; Dietz, R; Gavazzi, A; Van Gilst, WH; Hobbs, R; Madeira, HC; Moiseyev, VS; Preda, [No Value; Widimsky, J; Freemanthle, N; Eastaugh, J; Mason, J

    Background National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro, Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in

  4. Up-Beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients

    Directory of Open Access Journals (Sweden)

    Pariante Carmine M

    2011-05-01

    Full Text Available Abstract Background Coronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide. Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain. In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease, however it is unclear how general practitioners should manage these patients. We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression. Methods/design This programme of research will consist of 4 inter-related studies. A 4 year prospective cohort study of primary care patients with coronary heart disease will be conducted to explore the relationship between coronary heart disease and depression. Within this, a nested case-control biological study will investigate genetic and blood-biomarkers as predictors of depression in this sample. Two qualitative studies, one of patients' perspectives of treatments for coronary heart disease and co-morbid depression and one of primary care professionals' views on the management of patients with coronary heart disease and depression will inform the development of an intervention for this patient group. A feasibility study for a randomised controlled trial will then be conducted. Discussion This study will provide information on the relationship between coronary heart disease and depression that will allow health services to determine the efficiency of case-finding for depression in this patient group. The results of the cohort study will also provide information on risk factors for depression. The study will provide evidence on the efficacy and feasibility of a joint patient and professional led intervention and data necessary to plan a

  5. Assessment of an educational intervention on nurses' knowledge and retention of heart failure self-care principles and the Teach Back method.

    Science.gov (United States)

    Mahramus, Tara; Penoyer, Daleen Aragon; Frewin, Sarah; Chamberlain, Lyne; Wilson, Debra; Sole, Mary Lou

    2014-01-01

    Nurses must have optimum knowledge of heart failure self-care principles to adequately prepare patients for self-care at home. However, study findings demonstrate that nurses have knowledge deficits in self-care concepts for heart failure. A quasi-experimental, repeated measures design was used to assess nurses' knowledge of heart failure self-care before, immediately after, and 3-months following an educational intervention, which also included the Teach Back method. Follow-up reinforcement was provided after the educational intervention. One hundred fifty nurses participated in the study. Significant differences were found between pre-test (65.1%) and post-test (80.6%) scores (p assessment of knowledge. In this group, mean knowledge scores increased significantly across all three measurements (p principles and the knowledge was sustained and increased over time. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Frequency of Cardiorenal Syndrome Type-I in Hospitalized Children with Acute Heart Failure in a Tertiary-Care Hospital

    International Nuclear Information System (INIS)

    Zaidi, M.; Rahman, A. J.; Haque, A.; Sadqani, S.; Maheshwari, P. K.

    2014-01-01

    Objective: To determine the frequency of cardiorenal syndrome in hospitalized children with acute heart failure. Study Design: Descriptive study. Place and Duration of Study: Paediatric Intensive Care Unit, The Aga Khan University Hospital, Karachi, from December 2010 to December 2011. Methodology: Sixty eight (68) children with acute heart failure fulfilling the selection criteria were evaluated for worsening of renal function (WRF). Serum creatinine was done at baseline and repeated at 72 hours to see the worsening of renal function. Estimated serum creatinine clearance was calculated by Schwartz formula. Results: Mean age of patients was 43.6 +- 55.2 months. There were 43 (63%) males, 70% were under 57 months of age. Mean weight on admission was 14.7 +- 19.13 kg and mean height was 83 cm (+- 31.08 SD). Mean serum creatinine on admission was 0.77 mg/dl (+- 1.18 SD). Worsening renal function was noted in 55 (81%) of children, out of those, majority 36 (70.5%) were under 5 years of age. Conclusion: Worsening renal function was found in 81% of children admitted with the diagnosis of acute heart failure. Majority (70.5%) were under 5 years of age indicating a closer observation of renal status in younger age group to reduce, morbidity and mortality. (author)

  7. The Memory Quilt: Heart-and-Hands Learning for Palliative Care.

    Science.gov (United States)

    Flanagan, Patricia; DeMetro, Nancy

    Nursing students' learning of adult and pediatric palliative care is a daunting experience. An effective initial teaching strategy using a Memory Quilt activity can improve nursing students' interpersonal and communication skills and help prepare them for end-of-life caring. These skills help students meet patient and family needs, as they transition to care settings.

  8. Health care providers and human trafficking: What do they know, what do they need to know? Findings from the middle East, the Caribbean, and Central America

    NARCIS (Netherlands)

    Viergever, R.F.; West, H.; Borland, R.; Zimmerman, C.

    2015-01-01

    BACKGROUND: Human trafficking is a crime that commonly results in acute and chronic physical and psychological harm. To foster more informed health sector responses to human trafficking, training sessions for health care providers were developed and pilot-tested in the Middle East, Central America,

  9. Child rearing in a group setting: beliefs of Dutch, Caribbean Dutch, and Mediterranean Dutch caregivers in center-based child care

    NARCIS (Netherlands)

    Huijbregts, S.K.; Tavecchio, L.; Leseman, P.; Hoffenaar, P.

    2009-01-01

    Child care centers in Western countries are becoming increasingly culturally diverse, regarding both professional caregivers, children, and their parents. Child-rearing beliefs, which differ between cultures, are found to affect process quality and children’s developmental outcomes. The first aim of

  10. Practical guidance on heart failure diagnosis and management in primary care : Recent EPCCS recommendations

    NARCIS (Netherlands)

    Taylor, Clare J; Rutten, Frans H.; Brouwer, Judith R; Hobbs, F. D.Richard

    2017-01-01

    Heart failure (HF) is a common and costly clinical syndrome, associated with significant morbidity and reduced life expectancy, affecting around 1–2% of adults in developed countries.1 Timely diagnosis is important to optimise evidence-based treatment opportunities, which delay mortality and improve

  11. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Soljak Michael

    2007-06-01

    Full Text Available Abstract Background Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP Contract. Methods We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke Quality and Outcomes Framework (QOF indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. Results Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively. Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P Conclusion The volume-outcome relationship found in hospital settings is not seen between practices in the UK in management of cardiovascular disorders in primary care

  12. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study.

    Science.gov (United States)

    Saxena, Sonia; Car, Josip; Eldred, Darren; Soljak, Michael; Majeed, Azeem

    2007-06-27

    Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP) Contract. We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke) Quality and Outcomes Framework (QOF) indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively). Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P < 0.0001) for referral for exercise testing and specialist assessment of patients with newly diagnosed angina. The volume-outcome relationship found in hospital settings is not seen between practices in the UK in

  13. Clinical guidelines for Western clinicians engaged in primary care medical service trips in Latin America and the Caribbean: an integrative literature review.

    Science.gov (United States)

    Dainton, Christopher; Chu, Charlene H; Lin, Henry; Loh, Lawrence

    2016-04-01

    Participation in primary care-focused medical service trips (MSTs) by North American providers is increasingly common, with many of these being conducted in Latin America. The literature has yet to comprehensively explore the nature of MST practice, including the use of evidence-based clinical guidelines. This integrative review presents an analysis of guidelines employed in MSTs in Latin America. MEDLINE and LILACs were searched using the terms 'medical brigades', 'Latin America', 'primary health care' and related terms. The search was limited to articles published between 2000 and 2015 in any language. Qualitative or quantitative articles were subsequently included if they described management protocols in the context of patient care on an MST occurring in Latin America. Additional publications were identified by searching the citations of articles reviewed in full. Themes were extracted to an Excel file, and objective instruments were used to evaluate article quality (Mixed Methods Assessment Tool) and the quality of guidelines (Appraisal of Guidelines for Research & Evaluation II). Of 391 abstracts screened, eight met inclusion criteria. All described MSTs operating in rural settings in Central America. Five were qualitative descriptive, including two travel reports, an ethics thesis paper, and a description of a dermatologic MST. Four described subjective clinician experiences while describing non-evidence-based treatment suggestions or practices. Only one described evidence-supported primary care interventions. Three studies were quantitative descriptive, including two epidemiological articles, one of which used case definitions for select diagnoses. One described the application of American Family Physician guidelines to the description of UTI prevalence on a MST. Article scores in MMAT quality domains were variable, and only one article achieved a positive overall AGREE II score for guideline quality. Existing literature demonstrates minimal development or

  14. Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry.

    Science.gov (United States)

    Chioncel, Ovidiu; Ambrosy, Andrew P; Filipescu, Daniela; Bubenek, Serban; Vinereanu, Dragos; Petris, Antoniu; Collins, Sean P; Macarie, Cezar; Gheorghiade, Mihai

    2015-05-01

    The present study aims to describe the epidemiology, baseline clinical characteristics, in-hospital management, and outcome of patients hospitalized for heart failure admitted directly or transferred to the ICU. The Romanian Acute Heart Failure Syndromes (RO-AHFS) registry prospectively enrolled 3224 consecutive patients between January 2008 and May 2009 admitted with a primary diagnosis of heart failure. Participants were classified by ICU admission status (i.e. ICU+/ICU-). Independent clinical predictors of ICU admission and in-hospital mortality were identified using multivariable logistic regression analysis. Overall, 10.7% of patients required ICU level care, 32% as a direct ICU admission, with 68% as an ICU transfer during hospitalization. Patients admitted to the ICU had a mean age of 68.1 ± 11.3 years, 61% were men, 67% had an ischemic cause, and 44% presented with de-novo heart failure. ICU+ patients more frequently presented with low SBP and pulse pressure and abnormal renal function. Mechanical ventilation was required in 32.7% and intravenous inotropes were administered to 56.7% of ICU+ patients. ICU+ patients had higher in-hospital mortality compared to ICU- patients (17.3 vs. 6.5%). Patients admitted directly to the ICU had a 15.3% mortality rate compared to 18.4% in those transferred after admission. Age, serum sodium, SBP below 110 mmHg, and left-ventricular ejection fraction less than 45% were predictive of ICU admission, whereas for ICU+ patients, age, vasopressor, and mechanical ventilation utilization were predictive of mortality. Patients admitted directly or transferred to the ICU are at a high risk of in-hospital mortality. Clinical variables commonly measured at the time of admission may facilitate disposition decision-making including early triage to the ICU.

  15. Nursing approach in primary care of diabetes and heart as a key tool for prevention, care and promotion

    Directory of Open Access Journals (Sweden)

    Daulys Alessa Mendinueta Marin

    2017-01-01

    Full Text Available Currently it is clear the impact of primary care for people with diabetes and the belief that education about this disease is indispensable in the therapeutic approach, as this can contribute to an individualized patient plan that allows their subsequent treatment and the preservation of their health. Therefore, the nursing professional and the family should play a leading role, in performing preventive and educational activities, and rehabilitative care through building individual and community strategies. In the following guide you will find a series of interventions in primary care, such as: the role of the nurse and the vision of her in diabetes, assessment, monitoring and implementation of the model of Callista Roy, nursing care process, nutritional recommendations and indicators about the patient and family; in order to decrease risk factors and prevent such diseases.

  16. Running nurse-led secondary prevention clinics for coronary heart disease in primary care: qualitative study of health professionals' perspectives.

    Science.gov (United States)

    Murchie, Peter; Campbell, Neil C; Ritchie, Lewis D; Thain, Joan

    2005-07-01

    A randomised trial of nurse-led secondary prevention clinics for coronary heart disease resulted in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up. This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics. To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care. Semi-structured audiotaped telephone interviews with GPs and nurses involved in running clinics. A stratified, random sample of 19 urban, suburban, and rural general practices in north-east Scotland. Semi-structured telephone interviews with 19 GPs and 17 practice-based nurses involved in running nurse-led clinics for the secondary prevention of coronary heart disease. Eight practices had run clinics continuously and 11 had stopped, with eight subsequently restarting. Participants accounted for these patterns by referring to advantages and disadvantages of the clinics in four areas: patient care, development of nursing skills, team working, and infrastructure. Most practitioners perceived benefits for patients from attending secondary prevention clinics, but some, from small rural practices, thought they were unnecessary. The extended role for nurses was welcomed, but was dependent on motivated staff, appropriate training and support. Clinics relied on, and could enhance, team working, however, some doctors were wary of delegating. With regard to infrastructure, staff shortages (especially nurses) and accommodation were as problematic as lack of funds. Nurse-led secondary prevention clinics were viewed positively by most healthcare professionals that had been involved in running them, but barriers to their implementation had led most to stop running them at some point. Lack of space and staff shortages are likely to remain ongoing problems, but improvements in funding training and communication within

  17. Clinical characteristics and outcomes of Yemeni patients with acute heart failure aged 50years or younger: Data from Gulf Acute Heart Failure Registry (Gulf CARE).

    Science.gov (United States)

    Munibari, A-Nasser; Al-Motarreb, Ahmed; Al-Sagheer, Nora; Hadi, Hana Abu; Othman, Ali; Al-Wather, Nawar; Hamoud, Abdu; Alawlagy, Mutae; Almehdar, Salem; Alhammadi, Abdulkarim; Almogayed, Mohammed; Caretta, Giorgio; Al Jabri, Anees; Agati, Luciano

    2017-02-15

    There is a shortage of data about acute heart failure (AHF) in the young, including its underlying causes, clinical presentation and outcomes. We aim to describe clinical characteristics, causes and outcomes of AHF in Yemeni patients aged 50years or younger. we evaluated Yemeni patients with AHF enrolled in Gulf CARE registry. Patients were divided into two groups: young patients (≤50years) and older patients (>50years). A total of 1536 patients with AHF were enrolled, of whom 635 (41.3%) were 50years old or younger. The mean age for this group was 38.8 (±9.5) years; and 399 (62.8%) were males. Younger patients had a higher prevalence of non-ischemic cardiomyopathy (41% vs 11.1%, pvalvular disease (27.9% vs 3.2%, pdisease (61.6% vs 25.5%, pdisease (18.3% vs 6.3%, p<0.001) were more frequent in the elderly group. Cardiogenic shock was more frequent among younger patients (13.7% vs 7.0, p<0.001). In-hospital mortality was higher in patient aged ≤50years (12% vs 7.6%, p=0.002) while no difference in all-cause mortality was present at 3months (17.8 vs 14.5, p=0.089) and after 1year (21.9% vs 20.6%, p=0.56). This analysis of Gulf CARE registry represents the largest report of patients admitted with AHF in Yemen. There were differences among cause of HF and precipitating factors of AHF among younger and elderly patients. Younger patients had higher in-hospital mortality and more severe clinical condition at admission. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties.

    Science.gov (United States)

    Sommerhalter, Kristin M; Insaf, Tabassum Z; Akkaya-Hocagil, Tugba; McGarry, Claire E; Farr, Sherry L; Downing, Karrie F; Lui, George K; Zaidi, Ali N; Van Zutphen, Alissa R

    2017-11-01

    Many individuals with congenital heart defects (CHDs) discontinue cardiac care in adolescence, putting them at risk of adverse health outcomes. Because geographic barriers may contribute to cessation of care, we sought to characterize geographic access to comprehensive cardiac care among adolescents with CHDs. Using a population-based, 11-county surveillance system of CHDs in New York, we characterized proximity to the nearest pediatric cardiac surgical care center among adolescents aged 11 to 19 years with CHDs. Residential addresses were extracted from surveillance records documenting 2008 to 2010 healthcare encounters. Addresses were geocoded using ArcGIS and the New York State Street and Address Maintenance Program, a statewide address point database. One-way drive and public transit time from residence to nearest center were calculated using R packages gmapsdistance and rgeos with the Google Maps Distance Matrix application programming interface. A marginal model was constructed to identify predictors associated with one-way travel time. We identified 2522 adolescents with 3058 corresponding residential addresses and 12 pediatric cardiac surgical care centers. The median drive time from residence to nearest center was 18.3 min, and drive time was 30 min or less for 2475 (80.9%) addresses. Predicted drive time was longest for rural western addresses in high poverty census tracts (68.7 min). Public transit was available for most residences in urban areas but for few in rural areas. We identified areas with geographic barriers to surgical care. Future research is needed to determine how these barriers influence continuity of care among adolescents with CHDs. Birth Defects Research 109:1494-1503, 2017.© 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  19. Perceptions and Acceptability of Receiving SMS Self-care Messages in Chinese Patients With Heart Failure: An Inpatient Survey.

    Science.gov (United States)

    Li, Xiao; Chen, Chen; Qu, Mo-Ying; Li, Zhi; Xu, Ying; Duan, Xue-Fei; Chen, Xi; Zhang, Qing; You, Gui-Ying

    Self-care is critical for postdischarge heart failure (HF) patients. Short message service (SMS) is a promising way to promote HF self-care. The aim of this study is to investigate knowledge status in Chinese HF patients, as well as the acceptance of SMS as a way to improve self-care. A survey using a self-developed questionnaire was conducted in patients with decompensated HF 2 days before discharge. A total of 540 patients completed the survey. Among them, only 69.8% and 63.3% of patients were aware of their HF status and medication regimen, respectively. A total of 95.6% patients were willing to receive SMS. Patient himself/herself, caregiver, or both patient and caregiver were almost equally selected as the preferred receiver of SMS. Educational and/or reminder SMS was considered "very helpful" by 50.2% of the patients as a way of promoting self-care, similar to that of telephone education and brochure education. "Take your medicine", "avoid getting flu," and "keep follow-up" were regarded as the most important self-care contents, whereas "weigh yourself every day" and "restrict fluid intake" were considered the least important. As a way of promoting HF self-care, SMS intervention combining educational and reminder function might be well accepted by HF patients in China. The status of HF, medication, weight control, and fluid restriction should be emphasized during the practice. Caution should be drawn as the survey was not tested elsewhere. Further clinical trials would be conducted to examine the effect of SMS intervention on self-care behaviors and outcomes of HF patients.

  20. Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries Desigualdades de salud en América Latina y el Caribe: resultados descriptivos y exploratorios basados en la autonotificación de problemas de salud y atención de salud en doce países

    OpenAIRE

    J. Norberto W. Dachs; Marcela Ferrer; Carmen Elisa Florez; Aluisio J. D. Barros; Rory Narváez; Martín Valdivia

    2002-01-01

    Objective. To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods. A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and p...

  1. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Jauch, Edward C; Cucchiara, Brett; Adeoye, Opeolu; Meurer, William; Brice, Jane; Chan, Yvonne Yu-Feng; Gentile, Nina; Hazinski, Mary Fran

    2010-11-02

    Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

  2. Ultrasound for critical care physicians: now my heart is even more full

    Directory of Open Access Journals (Sweden)

    Jalil B

    2015-02-01

    Full Text Available No abstract available. Article truncated after first page. A 49-year-old man with type 2 diabetes, intravenous drug abuse and heart failure presented to the emergency room with 2 weeks of progressively worsening chest pain, lower extremity swelling and shortness of breath. The patient was found to have an elevated troponin as well as brain natriuretic peptide and the absence of ischemic electrocardiogram findings. The patient was admitted to the medical ICU for hypoxic respiratory failure and shock of uncertain etiology. Clinically he seemed to be in decompensated heart failure and a bedside echocardiogram was performed (Figures 1 and 2. What is the best explanation for the echocardiographic findings shown above? 1. Atrial myxoma; 2. Cardiac amyloidosis; 3. Cardiac lymphoma; 4. Takotsubo cardiomyopathy; 5. Tricuspid valve endocarditis ...

  3. Heart defects treatment in Sergipe: propose of resources' rationalization to improve care.

    Science.gov (United States)

    Leite, Debora Cristina Fontes; de Mendonça, José Teles; Cipolotti, Rosana; de Melo, Enaldo Viera

    2012-01-01

    This study aims evaluate the treatment of congenital heart disease conducted from 2000 to 2009. The sample consisted of all patients undergoing surgical correction for congenital heart disease for ten years in Sergipe, Brazil. The patients were operated in three hospitals located in the city of Aracaju, capital of the state of Sergipe (Brazil). The study was divided into two periods defined by the start date of centralization of surgery. The variables collected were: age, sex, postoperative diagnosis, destination, type of surgery and hospital where the procedure was performed and the classification RACHS -1. In the period I, the estimate deficit of surgery was 69% decrease occurring in the period II to 55.3%. The postoperative diagnosis was more frequent closure of the interventricular communication (20.5%), closure of patent ductus arteriosus (20.2%) and atrial septal defect (19%). There was a statistically significant correlation between the expected mortality RACHS-1 and observed in the sample. The evaluation of RACHS-1 as a predictor of hospital mortality by ROC curve showed area of 0.860 95% CI 0.818 to 0.902 with P <0.0001. The results of this study indicate that the centralization and organization of existing resources are needed to improve the performance of surgical correction of congenital heart diseases.

  4. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Riegel, Barbara; Moser, Debra K; Buck, Harleah G; Dickson, Victoria Vaughan; Dunbar, Sandra B; Lee, Christopher S; Lennie, Terry A; Lindenfeld, JoAnn; Mitchell, Judith E; Treat-Jacobson, Diane J; Webber, David E

    2017-08-31

    Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities.

    Science.gov (United States)

    Lum, Hillary; Obafemi, Oluyomi; Dukes, Joanna; Nowels, Molly; Samon, Kristina; Boxer, Rebecca S

    2017-10-01

    Individuals with heart failure (HF) who are hospitalized and admitted to skilled nursing facilities (SNFs) are at high risk for rehospitalization and death. The care preferences of this high-risk population have not been studied. To describe care preferences of patients with HF admitted to SNFs for rehabilitation based on Medical Orders for Scope of Treatment (MOST) documentation, and evaluate goal-concordant care based on MOST documentation, emergency department (ED) visits, and hospitalization. Retrospective study of patients with HF in 35 SNFs enrolled in a randomized controlled trial of HF-disease management versus usual care between July 2014 and May 2016. Validity of MOST forms, care preference documentation, and ED visits/hospitalizations within 60 days of SNF admission. Of 370 patients (mean age 78.6 years, 58% women, 25% systolic HF), 278 (75%) had a MOST form in the SNF chart, of which 96 forms (35%) were invalid. The most common reason for an invalid MOST form was missing date accompanying patient or provider signature. Of 182 valid MOST forms, 47% of patients chose no cardiopulmonary resuscitation ("No CPR"), 58% selected "Full Treatment," 17% chose "Selective Treatment," and 23% chose "Comfort-Focused Treatment." Patients who were older [odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.25, 1.81] and female (OR = 2.33, 95% CI = 1.18, 4.59) had higher odds of choosing "No CPR." Sixty-six of 182 patients (36%) with valid MOST forms had an ED/hospital visit within 60 days of SNF admission; only 3 patients received medical care that was potentially discordant: all 3 chose "Comfort-Focused Treatment" and were hospitalized for more than symptom management. Seventy-five percent of patients with HF admitted to SNFs had care preferences documented using the MOST form, and 95% received goal-concordant care based on care preferences documented during the SNF admission. Clinicaltrials.gov # NCT01822912. Copyright © 2017 AMDA – The Society for

  6. Quality of Care and Outcomes of Heart Failure Among Patients With Schizophrenia in Denmark

    DEFF Research Database (Denmark)

    Jørgensen, Mette; Mainz, Jan; Egstrup, Kenneth

    2017-01-01

    care among patients with schizophrenia included patient-specific factors (age, gender, Global Assessment of Functioning [GAF] score, alcohol or drug abuse, duration of schizophrenia); provider-specific factors (quality of schizophrenia care); and system-specific factors (patient-volume defined...

  7. Heart Attack Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – state data. This data set includes state-level data for payments associated with a 30-day episode of care for heart...

  8. Heart Attack Payment - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – provider data. This data set includes provider data for payments associated with a 30-day episode of care for heart...

  9. Heart Attack Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – national data. This data set includes national-level data for payments associated with a 30-day episode of care for heart...

  10. Caribbean Crucible: History, Culture, and Globalization.

    Science.gov (United States)

    Yelvington, Kevin A.

    2000-01-01

    Reconsiders the Caribbean as an origin-point of the modern global system. Discusses the conquests and colonization of the Caribbean; the slavery system and racial distinctions; the post-emancipation society; and culture, Creolization, and the concept of movement as features of Caribbean society. Provides a bibliography. (CMK)

  11. Disease management in the treatment of patients with chronic heart failure who have universal access to health care: a randomized controlled trial.

    Science.gov (United States)

    Kalter-Leibovici, Ofra; Freimark, Dov; Freedman, Laurence S; Kaufman, Galit; Ziv, Arnona; Murad, Havi; Benderly, Michal; Silverman, Barbara G; Friedman, Nurit; Cukierman-Yaffe, Tali; Asher, Elad; Grupper, Avishay; Goldman, Dorit; Amitai, Miriam; Matetzky, Shlomi; Shani, Mordechai; Silber, Haim

    2017-05-01

    The efficacy of disease management programs in improving the outcome of heart failure patients remains uncertain and may vary across health systems. This study explores whether a countrywide disease management program is superior to usual care in reducing adverse health outcomes and improving well-being among community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal access to advanced health-care services and technologies. In this multicenter open-label trial, 1,360 patients recruited after hospitalization for heart failure exacerbation (38%) or from the community (62%) were randomly assigned to either disease management or usual care. Disease management, delivered by multi-disciplinary teams, included coordination of care, patient education, monitoring disease symptoms and patient adherence to medication regimen, titration of drug therapy, and home tele-monitoring of body weight, blood pressure and heart rate. Patients assigned to usual care were treated by primary care practitioners and consultant cardiologists. The primary composite endpoint was the time elapsed till first hospital admission for heart failure exacerbation or death from any cause. Secondary endpoints included the number of all hospital admissions, health-related quality of life and depression during follow-up. Intention-to-treat comparisons between treatments were adjusted for baseline patient data and study center. During the follow-up, 388 (56.9%) patients assigned to disease management and 387 (57.1%) assigned to usual care had a primary endpoint event. The median (range) time elapsed until the primary endpoint event or end of study was 2.0 (0-5.0) years among patients assigned to disease management, and 1.8 (0-5.0) years among patients assigned to usual care (adjusted hazard ratio, 0.908; 95% confidence interval, 0.788 to 1.047). Hospital admissions were mostly (70%) unrelated to heart failure. Patients assigned to disease management had a better

  12. Improving care for people with heart failure in Uganda: serial in-depth interviews with patients' and their health care professionals.

    Science.gov (United States)

    Namukwaya, Elizabeth; Grant, Liz; Downing, Julia; Leng, Mhoira; Murray, Scott A

    2017-05-25

    The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjective, have not been described from the patients' and health care professionals'(HPs) view point in the Ugandan setting, a low income country with a different socio-cultural context. This study aimed at bridging this gap in knowledge by eliciting patients' and HPs' views of HF patients' needs over the course of their illness to enable generalists, cardiologists and palliative care clinicians to develop guidelines to provide patient-centred realistic care in Uganda. Serial qualitative in-depth interviews were conducted with HF patients who were purposively sampled and recruited in Mulago National Referral Hospital (MNRH) until thematic saturation. In-depth interviews were conducted at three time points with intervals of 3 month between interviews over the course of their illness in the hospital and their home context. One-off interviews were conducted with HPs that manage HF in MNRH. We used a grounded theory approach in data analysis. The Uganda National Council of science and technology approved the research. Forty-eight interviews were conducted with 21 patients and their carers and eight interviews with their HPs. Multidimensional needs including physical, psychological, social, spiritual and information needs were identified. These highlighted the underpinning need to have normal functioning, control, to cope and adapt to a changed life and to find meaning. Spiritual needs were less recognised by HPs than the other multidimensional needs. Information needs were commonly unmet. Patients and HPs suggested improvements in care that were congruent with the recommendations in chronic disease care and the six pillars of the WHO

  13. Leading from the heart: caring, love, peace, and values guiding leadership.

    Science.gov (United States)

    Turkel, Marian C

    2014-04-01

    Contemporary transformational leadership focuses on authentic leadership styles, relational caring, meaningful recognition, creativity, building trust, relationships, participative decision making, dialogue with time for reflection, and innovation. The purpose of this paper is to illuminate how concepts from the unitary transformative paradigm and caring science can be integrated within nursing leadership practice, to invite nurse leaders to make these concepts explicit in their own transformational leadership journey, and to offer ways of reframing traditional organizational language. Practice exemplars are presented to highlight how tenets from caring theory are guiding the practice of nursing leadership.

  14. Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS).

    Science.gov (United States)

    Masterson Creber, Ruth M; Maurer, Mathew S; Reading, Meghan; Hiraldo, Grenny; Hickey, Kathleen T; Iribarren, Sarah

    2016-06-14

    Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, "heart failure," "cardiology," "heart failure and self-management"). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. This review suggests

  15. "Not the 'grim reaper service'": an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure.

    Science.gov (United States)

    Kavalieratos, Dio; Mitchell, Emma M; Carey, Timothy S; Dev, Sandesh; Biddle, Andrea K; Reeve, Bryce B; Abernethy, Amy P; Weinberger, Morris

    2014-01-02

    Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. We conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF-related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration. Palliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease-related burden.

  16. “Not the ‘Grim Reaper Service’”: An Assessment of Provider Knowledge, Attitudes, and Perceptions Regarding Palliative Care Referral Barriers in Heart Failure

    Science.gov (United States)

    Kavalieratos, Dio; Mitchell, Emma M.; Carey, Timothy S.; Dev, Sandesh; Biddle, Andrea K.; Reeve, Bryce B.; Abernethy, Amy P.; Weinberger, Morris

    2014-01-01

    Background Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. Methods and Results We conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF‐related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration. Conclusions Palliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease‐related burden. PMID:24385453

  17. Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer.

    Science.gov (United States)

    Setoguchi, Soko; Glynn, Robert J; Stedman, Margaret; Flavell, Carol M; Levin, Raisa; Stevenson, Lynne Warner

    2010-07-01

    Advances in heart failure (HF) treatments have prolonged survival, but more patients die of HF than of any type of cancer. Little is known about the current practice in end-of-life (EOL) care in HF. Two EOL cohorts (HF and cancer) were identified using Medicare data linked with pharmacy and cancer registry data. We assessed use of hospice, opiates, and acute care services (hospitalizations, emergency department [ED] visits, intensive care unit [ICU] admissions, and death in acute care). Time trends and predictors of use were assessed using multivariate regression including demographics and cardiovascular and noncardiovasuclar comorbidities. Among 5,836 HF patients with median age of 85, 77% female and 4% black, 20% were referred to hospice compared to 51% of 7,565 cancer patients. A modest rise in hospice use over time was parallel in the 2 groups. Twenty-two percent of HF patients filled opiate prescriptions during 60 days before death compared to 46% of cancer patients. Use of acute care services in the 30 days before death was higher for HF (64% vs 39% for ED visits, 60% vs 45% for hospitalizations, and 19% vs 7% for ICU admission). More HF patients died during acute hospitalizations than cancer patients (39% vs 21%). Patients dying of HF were less likely to be supported by hospice and opiates but more likely to die in hospitals than patients with cancer. Our study suggests that opportunities may exist to improve hospice and opiate use in HF patients. Copyright (c) 2010 Mosby, Inc. All rights reserved.

  18. Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Diemand Albert

    2011-03-01

    Full Text Available Abstract Background Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT for cardiac troponin T (cTnT, N-terminal pro-brain natriuretic peptide (NT-proBNP and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS, heart failure (HF and thromboembolic events (TE is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care. Methods Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls. Men and women presenting in 68 primary care practices in Zurich County (Switzerland with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups. Results The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002, as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002. All three biomarker tests showed good sensitivity and specificity. Conclusion POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients. Trial registration DRKS: DRKS00000709

  19. Immediate effects of reiki on heart rate variability, cortisol levels, and body temperature in health care professionals with burnout.

    Science.gov (United States)

    Díaz-Rodríguez, Lourdes; Arroyo-Morales, Manuel; Fernández-de-las-Peñas, Cesar; García-Lafuente, Francisca; García-Royo, Carmen; Tomás-Rojas, Inmaculada

    2011-10-01

    Burnout is a work-related mental health impairment comprising three dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. Reiki aims to help replenish and rebalance the body's energetic system, thus stimulating the healing process. The objective of this placebo-controlled, repeated measures, crossover, single-blind, randomized trial was to analyze the immediate effects of Reiki on heart rate variability (HRV), body temperature, and salivary flow rate and cortisol level in health care professionals with burnout syndrome (BS). Participants included 21 health care professionals with BS, who were asked to complete two visits to the laboratory with a 1-week interval between sessions. They were randomly assigned the order in which they would receive a Reiki session applied by an experienced therapist and a placebo treatment applied by a therapist with no knowledge of Reiki, who mimicked the Reiki treatment. Temperature, Holter ECG recordings (standard deviation of the normal-to-normal interval [SDNN], square root of mean squared differences of successive NN intervals [RMSSD], HRV index, low frequency component [LF], and high frequency component [HF]), salivary flow rate and cortisol levels were measured at baseline and postintervention by an assessor blinded to allocation group. SDNN and body temperature were significantly higher after the Reiki treatment than after the placebo. LF was significantly lower after the Reiki treatment. The decrease in the LF domain was associated with the increase in body temperature. These results suggest that Reiki has an effect on the parasympathetic nervous system when applied to health care professionals with BS.

  20. Clinicians' perspectives on patient satisfaction in adult congenital heart disease clinics--a dimension of health care quality whose time has come.

    Science.gov (United States)

    Rozenblum, Ronen; Gianola, Ann; Ionescu-Ittu, Raluca; Verstappen, Amy; Landzberg, Michael; Gurvitz, Michelle; Jenkins, Kathy; Bates, David W; Marelli, Ariane J

    2015-01-01

    Patient-centered care and patient satisfaction represent key dimensions of health care quality. This is relevant for the growing number of patients with life-long conditions. In the present study, our goal was to examine clinicians' attitudes and behavior with respect to patient satisfaction in adult congenital heart disease outpatient clinics. A 34-question survey was developed to assess adult congenital heart disease clinicians' awareness, attitudes, and behavior relative to patient satisfaction and administered in-person or online to clinicians from the largely U.S.-based Adult Congenital Heart Association's database of adult congenital heart disease health care providers. Overall, 267 questionnaires were filled out: 108 were collected in person (79% response rate) and 159 online (17.5% response rate). Responses were received from physicians (161); nurses (73); physician assistants (20); and others (13). Although 85% of clinicians believed it was important to inquire about patient satisfaction, only 28% reported routinely inquiring about this dimension of care. Only 34% claimed they had adequate training to cope with varying levels of patient satisfaction, 44% stated that their department utilized patient satisfaction surveys, and 37% received feedback from the hospital management in the preceding 12 months. In multivariate analyses, clinicians that received feedback from the hospital management and had adequate training were more likely to inquire about patient satisfaction. Although patient satisfaction is perceived as an important dimension of quality care by adult congenital heart disease clinicians, most of them reported insufficient institutional support to achieve this. Our findings suggest that clinicians would benefit from health care organizations engaging them in the delivery of this dimension of health care quality. © 2014 Wiley Periodicals, Inc.

  1. Case management for patients with chronic systolic heart failure in primary care: the HICMan exploratory randomised controlled trial.

    Science.gov (United States)

    Peters-Klimm, Frank; Campbell, Stephen; Hermann, Katja; Kunz, Cornelia U; Müller-Tasch, Thomas; Szecsenyi, Joachim

    2010-05-17

    Chronic (systolic) heart failure (CHF) represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role) and supported by general practitioners (GPs). This patient-randomised controlled trial (phase II) included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99) consisting of telephone monitoring and home visits or usual care (n = 100) for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ), CHF self-care (EHFScBS) and on quality of care (PACIC-5A). To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists) in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD) were 25.4 (8.4) and 25.0 (7.1). KCCQ overall summary scores (SD) were 65.4 (22.6) and 64.7 (22.7). We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6]) and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8]) improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]). In this sample, with little room for improvement regarding evidence-based pharmacotherapy and CHF self-care, case

  2. Prospective care of heart failure in Japan: lessons from CHART studies.

    Science.gov (United States)

    Shiba, Nobuyuki; Shimokawa, Hiroaki

    2011-12-01

    There are approximately 23 million patients with heart failure (HF) worldwide. The prognosis of patients with HF is still poor and a prospective approach for preventing and treating HF is necessary. The number of HF patients in Japan has been increasing since 1950 mainly because of a rapidly aging population. Furthermore, westernized dietary pattern, reduced physical activity, and obesity have become prominent, particularly in younger Japanese men. There is an increasing trend of diabetes and dyslipidemia, and the prevalence of smoking and hypertension continues to remain high. One of the largest HF cohorts in Japan, the CHART Studies, showed that coronary artery disease (CAD) was the most frequent etiology of HF currently. Thus, prospective strategies including accurate risk stratification, effective prevention of disease progression through evidence-based treatments, optimally personalized treatment particularly in elderly individuals, and life-long control of CAD risk factors are required to manage HF in Japan.

  3. Defining and dividing the greater Caribbean: insights from the biogeography of shorefishes.

    Directory of Open Access Journals (Sweden)

    D Ross Robertson

    Full Text Available The Greater Caribbean biogeographic region is the high-diversity heart of the Tropical West Atlantic, one of four global centers of tropical marine biodiversity. The traditional view of the Greater Caribbean is that it is limited to the Caribbean, West Indies, southwest Gulf of Mexico and tip of Florida, and that, due to its faunal homogeneity, lacks major provincial subdivisions. In this scenario the northern 2/3 of the Gulf of Mexico and southeastern USA represent a separate temperate, "Carolinian" biogeographic region. We completed a comprehensive re-assessment of the biogeography of the Greater Caribbean by comparing the distributions of 1,559 shorefish species within 45 sections of shelf waters of the Greater Caribbean and adjacent areas. This analysis shows that that the Greater Caribbean occupies a much larger area than usually thought, extending south to at least Guyana, and north to encompass the entire Carolinian area. Rather than being homogenous, the Greater Caribbean is divided into three major provinces, each with a distinctive, primarily tropical fauna: (1 a central, tropical province comprising the West Indies, Bermuda and Central America; (2 a southern, upwelling-affected province spanning the entire continental shelf of northern South America; and (iii a northern, subtropical province that includes all of the Gulf of Mexico, Florida and southeastern USA. This three-province pattern holds for both reef- and soft bottom fishes, indicating a general response by demersal fishes to major variation in provincial shelf environments. Such environmental differences include latitudinal variation in sea temperature, availability of major habitats (coral reefs, soft bottom shorelines, and mangroves, and nutrient additions from upwelling areas and large rivers. The three-province arrangement of the Greater Caribbean broadly resembles and has a similar environmental basis to the provincial arrangement of its sister biogeographic region, the

  4. How insights from cardiovascular developmental biology have impacted the care of infants and children with congenital heart disease.

    Science.gov (United States)

    Chin, Alvin J; Saint-Jeannet, Jean-Pierre; Lo, Cecilia W

    2012-07-01

    To illustrate the impact developmental biology and genetics have already had on the clinical management of the million infants born worldwide each year with CHD, we have chosen three stories which have had particular relevance for pediatric cardiologists, cardiothoracic surgeons, cardiac anesthesiologists, and cardiac nurses. First, we show how Margaret Kirby's finding of the unexpected contribution of an ectodermal cell population - the cranial neural crest - to the aortic arch arteries and arterial pole of the embryonic avian heart provided a key impetus to the field of cardiovascular patterning. Recognition that a majority of patients affected by the neurocristopathy DiGeorge syndrome have a chromosome 22q11 deletion, have also spurred tremendous efforts to characterize the molecular mechanisms contributing to this pathology, assigning a major role to the transcription factor Tbx1. Second, synthesizing the work of the last two decades by many laboratories on a wide gamut of metazoans (invertebrates, tunicates, agnathans, teleosts, lungfish, amphibians, and amniotes), we review the >20 major modifications and additions to the ancient circulatory arrangement composed solely of a unicameral (one-chambered), contractile myocardial tube and a short proximal aorta. Two changes will be discussed in detail - the interposition of a second cardiac chamber in the circulation and the septation of the cardiac ventricle. By comparing the developmental genetic data of several model organisms, we can better understand the origin of the various components of the multicameral (multi-chambered) heart seen in humans. Third, Martina Brueckner's discovery that a faulty axonemal dynein was responsible for the phenotype of the iv/iv mouse (the first mammalian model of human heterotaxy) focused attention on the biology of cilia. We discuss how even the care of the complex cardiac and non-cardiac anomalies seen in heterotaxy syndrome, which have long seemed impervious to advancements in

  5. Evaluation of the Effect of Perceived Social Support on Promoting Self-Care Behaviors of Heart Failure Patients Referred to The Cardiovascular Research Center of Isfahan

    Science.gov (United States)

    Khaledi, Gholam Hassan; Mostafavi, Firoozeh; Eslami, Ahmad Ali; Rooh Afza, Hamidreza; Mostafavi, Firoozeh; Akbar, Hassanzadeh

    2015-01-01

    Background: Self-care is one of the most important aspects of treatment in patients with heart failure and ranks among the most important coping strategies against the events and stresses of life. Perceived social support plays an important role in performing self-care behaviors in these patients. Objectives: This study was conducted to evaluate the effect of perceived social support on promoting self-care behaviors among heart failure patients. Patients and Methods: This educational intervention with a randomized control group was performed on 64 heart failure patients referred to The Cardiovascular Research Center of Isfahan. The study population was divided randomly into two groups of intervention and control. The indicators of self-care behavior and perceived social support (before, immediately after, and 2 months after the intervention) were completed by the two groups. The intervention group received educational interventions in 120-minute sessions once a week for 4 weeks. SPSS software (version 20) was used for data analysis in addition to methods of descriptive and inferential statistics. Results: Based on the obtained results, educational intervention was effective in the improvement of perceived social support among our heart failure patients. The results also showed that an increase in perceived social support significantly promoted self-care behaviors in the case group after the intervention compared with the control group (P < 0.001). Conclusions: Perceived social support played an important role in improving the performance of self-care behaviors in our heart failure patients. Given the strengths of the present study, these findings can be considered in future research in this domain. PMID:26328063

  6. Prehistoric settlements in the Caribbean

    Directory of Open Access Journals (Sweden)

    Peter L. Drewett

    1997-11-01

    Full Text Available Mesoamerican archaeology has focused mainly on the ancient civilizations of the mainland, but knowledge of early settlement, society and economy in the Caribbean islands is essential for our understanding of the prehistory of the region as a whole. Institute staff and students are currently working in three islands: Puerto Rico, Tortola and Barbados.

  7. Sidney Mintz and Caribbean Studies

    Directory of Open Access Journals (Sweden)

    Michiel Baud

    2011-12-01

    Full Text Available Review of: Empirical Futures: Anthropologists and Historians Engage the Work of Sidney W. Mintz. George Baca, A isha Khan & Stephan Palmié (eds.. Chapel Hill: University of North Carolina Press, 2009. v + 232 pp. (Paper US$ 24.95 Three Ancient Colonies: Caribbean Themes and Variations. Sidney W. Mintz. Cambridge MA: Harvard University Press, 2010. xiv + 257 pp. (Cloth US$ 27.95 [First paragraph] There can be no doubt about the importance of U.S. anthropologist Sidney Mintz in the development of Caribbean Studies. His work has influenced both the historiography and anthropology of Caribbean slavery and the emergence of Caribbean peasant societies. Now two books have been published that interrogate the significance of his work. The first is an anthology that tries to build on Mintz’s ideas – as I will argue below, in a circumspect and not fully convincing way. In the second Mintz describes and compares the societies of Jamaica, Haiti, and Puerto Rico, and looks back on his work that started in the 1940s.

  8. PROspective MEmory Training to improve HEart failUre Self-care (PROMETHEUS): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Cameron, Jan; Rendell, Peter G; Ski, Chantal F; Kure, Christina E; McLennan, Skye N; Rose, Nathan S; Prior, David L; Thompson, David R

    2015-04-29

    Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients' health outcomes. Prospective memory, which is defined as memory to carry out future intentions, is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients. The objective of this study is to examine the effects of prospective memory training on patients' engagement in HF self-care and health outcomes, carer strain and quality of life. The proposed study is a randomised, controlled trial in which 200 patients diagnosed with HF, and their carers will be recruited from 3 major hospitals across Melbourne. Eligible patients with HF will be randomised to receive either: 1) The Virtual Week Training Program - a computerised prospective memory (PM) training program (intervention) or 2) non-adaptive computer-based word puzzles (active control). HF patients' baseline cognitive function will be compared to a healthy control group (n = 60) living independently in the community. Patients will undergo a comprehensive assessment of PM, neuropsychological functioning, self-care, physical, and emotional functioning. Assessments will take place at baseline, 4 weeks and 12 months following intervention. Carers will complete measures assessing quality of life, strain, perceived control in the management of the patients' HF symptoms, and ratings of the patients' level of engagement in HF self-care behaviours. If the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs. Australian New Zealand Clinical Trials Registry #366376; 27 May 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366376&isClinicalTrial=False .

  9. Smoking cessation interventions for patients with coronary heart disease and comorbidities: an observational cross-sectional study in primary care.

    Science.gov (United States)

    Blane, David N; Mackay, Daniel; Guthrie, Bruce; Mercer, Stewart W

    2017-02-01

    Little is known about how smoking cessation practices in primary care differ for patients with coronary heart disease (CHD) who have different comorbidities. To determine the association between different patterns of comorbidity and smoking rates and smoking cessation interventions in primary care for patients with CHD. Cross-sectional study of 81 456 adults with CHD in primary care in Scotland. Details of eight concordant physical comorbidities, 23 discordant physical comorbidities, and eight mental health comorbidities were extracted from electronic health records between April 2006 and March 2007. Multilevel binary logistic regression models were constructed to determine the association between these patterns of comorbidity and smoking status, smoking cessation advice, and smoking cessation medication (nicotine replacement therapy) prescribed. The most deprived quintile had nearly three times higher odds of being current smokers than the least deprived (odds ratio [OR] 2.76; 95% confidence interval [CI] = 2.49 to 3.05). People with CHD and two or more mental health comorbidities had more than twice the odds of being current smokers than those with no mental health conditions (OR 2.11; 95% CI = 1.99 to 2.24). Despite this, those with two or more mental health comorbidities (OR 0.77; 95% CI = 0.61 to 0.98) were less likely to receive smoking cessation advice, but absolute differences were small. Patterns of comorbidity are associated with variation in smoking status and the delivery of smoking cessation advice among people with CHD in primary care. Those from the most deprived areas and those with mental health problems are considerably more likely to be current smokers and require additional smoking cessation support. © British Journal of General Practice 2017.

  10. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    OBJECTIVE: To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF. DESIGN: The NRP was used to identify...

  11. Age- and sex-related differences in use of guideline-recommended care and mortality among patients with incident heart failure in Denmark

    DEFF Research Database (Denmark)

    Nakano, Anne; Egstrup, Kenneth; Svendsen, Marie Louise Overgaard

    2016-01-01

    BACKGROUND: data are sparse on age- and sex-related differences in use of guideline-recommended care and subsequent mortality among patients with heart failure (HF). METHODS: we identified 24,308 incident patients with a verified primary diagnosis of HF recorded during 2003-2010 in the Danish Hea...

  12. Heart Health - Brave Heart

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story Heart Health Brave Heart Past Issues / Winter 2009 Table of Contents For ... you can have a good life after a heart attack." Lifestyle Changes Surviving—and thriving—after such ...

  13. Prediction and early detection of delirium in the intensive care unit by using heart rate variability and machine learning.

    Science.gov (United States)

    Oh, Jooyoung; Cho, Dongrae; Park, Jaesub; Na, Se Hee; Kim, Jongin; Heo, Jaeseok; Shin, Cheung Soo; Kim, Jae-Jin; Park, Jin Young; Lee, Boreom

    2018-03-27

    Delirium is an important syndrome found in patients in the intensive care unit (ICU), however, it is usually under-recognized during treatment. This study was performed to investigate whether delirious patients can be successfully distinguished from non-delirious patients by using heart rate variability (HRV) and machine learning. Electrocardiography data of 140 patients was acquired during daily ICU care, and HRV data were analyzed. Delirium, including its type, severity, and etiologies, was evaluated daily by trained psychiatrists. HRV data and various machine learning algorithms including linear support vector machine (SVM), SVM with radial basis function (RBF) kernels, linear extreme learning machine (ELM), ELM with RBF kernels, linear discriminant analysis, and quadratic discriminant analysis were utilized to distinguish delirium patients from non-delirium patients. HRV data of 4797 ECGs were included, and 39 patients had delirium at least once during their ICU stay. The maximum classification accuracy was acquired using SVM with RBF kernels. Our prediction method based on HRV with machine learning was comparable to previous delirium prediction models using massive amounts of clinical information. Our results show that autonomic alterations could be a significant feature of patients with delirium in the ICU, suggesting the potential for the automatic prediction and early detection of delirium based on HRV with machine learning.

  14. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure.

    Science.gov (United States)

    Wilson, Suprat Saely; Kwiatkowski, Gregory M; Millis, Scott R; Purakal, John D; Mahajan, Arushi P; Levy, Phillip D

    2017-01-01

    The purpose of this study was to compare health care resource utilization among patients who were given intravenous nitroglycerin for acute heart failure (AHF) in the emergency department (ED) by intermittent bolus, continuous infusion, or a combination of both. We retrospectively identified 395 patients that received nitroglycerin therapy in the ED for the treatment of AHF over a 5-year period. Patients that received intermittent bolus (n=124) were compared with continuous infusion therapy (n=182) and combination therapy of bolus and infusion (n=89). The primary outcomes were the frequency of intensive care unit (ICU) admission and hospital length of stay (LOS). On unadjusted analysis, rates of ICU admission were significantly lower in the bolus vs infusion and combination groups (48.4% vs 68.7% vs 83%, respectively; PICU admission rate remained, and hospital LOS was 1.9 days shorter compared with infusion therapy alone. Use of intubation (bolus [8.9%] vs infusion [8.8%] vs combination [16.9%]; P=.096) and bilevel positive airway pressure (bolus [26.6%] vs infusion [20.3%] vs combination [29.2%]; P=.21) were similar as was the incidence of hypotension, myocardial injury, and worsening renal function. In ED patients with AHF, intravenous nitroglycerin by intermittent bolus was associated with a lower ICU admission rate and a shorter hospital LOS compared with continuous infusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Making sense of health care delivery Where does the close to community health care worker fit in? - The case for congestive heart failure.

    Science.gov (United States)

    Iyngkaran, P; Biddargardi, N; Bastiampillai, T; Beneby, G

    2015-01-01

    Close to community health care workers (CTC-HCW) is an increasingly used term to describe the emergence of a new partner in health services delivery. In strengthening arguments for this part of the health workforce the authorities, health staffers, supporters, sceptics and perhaps clients will look to the academicians and the evidence base to determine the fate of this group. There is no doubt, CTC-HCW are a vital resource, whose importance is tied to socio-demo-geographic variables. Regardless of what the common perceptions of its importance are, the evolving evidence base could suggest either way. In this short commentary we would like to highlight the importance of a balanced and common sense approach in these arguments. An important example is heart failure where the majority have an associated comorbidity and one in four would also suffer with cognitive or mood disturbances. It is unclear how the CTC-HCW would fare for this devastating syndrome. In moving forward it is important we understand there are: strengths and limitations in the evidence gathering processes; indecision as to the questions; uncertainty of the starting points to gather evidence; and sociodemogeographic biases, which have to be factored before determining the fate of this much needed health care resource. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  16. [Cardiauvergne is a remote monitoring and care coordination service for patients with severe heart failure].

    Science.gov (United States)

    Boiteux, Marie-Claire; Rey, Philippe; Cadiou, Françoise; Chauvet, Caroline

    2016-11-01

    Since 2011, thanks to the cooperation of frontline healthcare professionals, it has provided care to more than 1 200 patients across the Auvergne health region. The organisation, blending telemedicine and human contact, has made this initiative a successful example of how the boundaries between community and hospital healthcare can be removed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. [Heart, arteries and women, a care pathway for women at high cardiovascular risk].

    Science.gov (United States)

    Mounier-Vehier, C; Boudghene, F; Delsart, P; Claisse, G; Kpogbemadou, N; Debarge, V; Letombe, B

    2014-06-01

    Cardiovascular (CV) diseases are the primary cause of death of women. Since they kill 10 times more than breast cancer, preventive measures should be implemented. According to U.S. recommendations, a woman is either at "CV risk" or at "optimal health status" if she has no risk factors and a perfectly healthy lifestyle. Some risk factors are more deleterious to women (smoking, diabetes, stress, depression, atrial fibrillation); or specific to women (preeclampsia, gestational diabetes, contraception, menopause, headaches). The lifestyle plays a key role for them. The blood pressure measurement is the most frequent opportunity to detect women at risk. CV tests should be performed to all symptomatic women and for those over the age of 45 who want to start practicing sport. The cardiologist can play a key role to improve women's CV health by integrating their hormonal risks. Women themselves can also make a powerful contribution to prevention by adopting a healthy lifestyle. From those recommendations concerning women's CV health, there is a great opportunity to initiate a health path for women at high cardiovascular risk. The objectives of the specific path "heart, arteries and women" of University hospital of Lille will be to improve professional practice, awareness of women, educate public authorities and within a few years reduce the epidemic of CVD of French women. Copyright © 2014. Published by Elsevier SAS.

  18. Experiences and Outcomes of Transition from Pediatric to Adult Health Care Services for Young People with Congenital Heart Disease: A Systematic Review.

    Science.gov (United States)

    Heery, Emily; Sheehan, Aisling M; While, Alison E; Coyne, Imelda

    2015-01-01

    This review synthesizes the empirical literature on outcomes and experiences of transfer and transition from pediatric to adult care for young people with congenital heart disease. A systematic review of papers published between January 2001 and May 2013 that examined outcomes or experiences of transfer and transition among young people with congenital heart disease was conducted. Data were extracted by two independent reviewers with the outcomes data combined using narrative synthesis and the experiences data integrated using thematic synthesis. Thirteen papers were included in the review: six reported outcomes following transfer, six reported experiences of transfer and transition, and one reported both outcomes and experiences. The review data indicate that high proportions of young people were lost to follow-up or experienced long gaps in care after leaving pediatric cardiology. Factors that protected against loss to follow-up or lapse in care included: beliefs that specialized adult care was necessary; poorer health status; attendance at pediatric appointments without parents; and pediatric referral to an adult congenital heart disease center. Data on experiences highlighted that many young people were unconcerned about transition, but lacked knowledge about their condition and were insufficiently prepared for transfer. In terms of adult services, many young people desired continuity in the quality of care, youth-oriented facilities, a personalized approach, and for their parents to remain involved in their care, but in a secondary, supportive capacity. In conclusion, the high proportions of young people lost to follow-up highlight the need for formal transition programs, which ensure a planned and coordinated transfer. Patients with congenital heart disease need education throughout adolescence about the implications of their condition, the differences between pediatric and adult services, and self-care management. © 2015 Wiley Periodicals, Inc.

  19. [Peculiarities of primary health care organization for patients suffering from chronic obstructive pulmonary disease jointly with coronary heart disease].

    Science.gov (United States)

    Власик, Любов Й; Ступницька, Ганна Я; Сухолотюк, Анастасія Л

    Combination of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) leads to some difficulties for diagnostics and for prescription of complex differential treatment as well as increasings risk of complications from the illness and drug's side effects. To develope peculiarities of Primary Health Care (PHC) organisation for patients suffering from COPD jointly with CHD; and to improve the patients surveillance for optimization of early diagnosis of named join pathology and well-timed prescription of appropriate health-promoting treatment. The COPD and CHD morbidity in Chernivtsi region and prevalence of CHD in 955 hospital cases were analyzed. Health survey of 241 patients of age more than 40 years was conducted according to Questionnaire for COPD primary monitoring on an outpatient basis. The decreasing of COPD detection (-15%) and decreasing of CHD morbidity (-7,7%) were observed in 2015. Primary disablement due to pulmonary diseases across the employable population increased on 28,8%. Analyses of smoking prevalence across the man older 40 years show that 97 (40,2%) of persons are smokers. Risk of COPD symptoms appearance in man older 40 was in more than 6 times bigger for smokers in comparison with non-smoking persons. CHD happens reliably more often (72,5%) in patients suffering from COPD of age 49-50 who smoke comparatively to non-smoking patients (48,7). An obligatory COPD primary monitoring in population risk groups and well-timed CHD diagnosis are main peculiarities of PHC organization for patients suffering from COPD jointly with CHD on primary health care level. Improvement of the surveillance for patients suffering from COPD jointly with CHD is also important on all population's health care levels.

  20. Comparison of pulseoximetry oxygen saturation and arterial oxygen saturation in open heart intensive care unit

    Directory of Open Access Journals (Sweden)

    Alireza Mahoori

    2013-08-01

    Full Text Available Background: Pulseoximetry is widely used in the critical care setting, currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SPO2 (puls-eoximetry oxygen saturation in intensive care unit after cardiac surgery. Our objective was to compare pulseoximetry with arterial oxygen saturation (SaO2 during clinical routine in such patients, and to examine the effect of mild acidosis on this relationship.Methods: In an observational prospective study 80 patients were evaluated in intensive care unit after cardiac surgery. SPO2 was recorded and compared with SaO2 obtained by blood gas analysis. One or serial arterial blood gas analyses (ABGs were performed via a radial artery line while a reliable pulseoximeter signal was present. One hundred thirty seven samples were collected and for each blood gas analyses, SaO2 and SPO2 we recorded.Results: O2 saturation as a marker of peripheral perfusion was measured by Pulseoxim-etry (SPO2. The mean difference between arterial oxygen saturation and pulseoximetry oxygen saturation was 0.12%±1.6%. A total of 137 paired readings demonstrated good correlation (r=0.754; P<0.0001 between changes in SPO2 and those in SaO2 in samples with normal hemoglobin. Also in forty seven samples with mild acidosis, paired readings demonstrated good correlation (r=0.799; P<0.0001 and the mean difference between SaO2 and SPO2 was 0.05%±1.5%.Conclusion: Data showed that in patients with stable hemodynamic and good signal quality, changes in pulseoximetry oxygen saturation reliably predict equivalent changes in arterial oxygen saturation. Mild acidosis doesn’t alter the relation between SPO2 and SaO2 to any clinically important extent. In conclusion, the pulse oximeter is useful to monitor oxygen saturation in patients with stable hemodynamic.

  1. Acutely decompensated heart failure: characteristics of hospitalized patients and opportunities to improve their care.

    Science.gov (United States)

    Sarmento, Pedro Moraes; Fonseca, Cândida; Marques, Filipa; Ceia, Fátima; Aleixo, Ana

    2006-01-01

    Heart failure (HF) remains a major public health problem in western countries, despite the enormous progress in its diagnosis and treatment. Acute and chronic decompensated HF are leading medical causes of hospitalization among people aged over 65 years in European countries, the USA, Australia and New Zealand. However, there have been few studies on acute and chronic decompensated HF and the European Society of Cardiology (ESC) guidelines on this subject have only just been published. To evaluate the overall prevalence of hospitalization due to HF according to its subtypes, comorbidities, and decompensating factors, in the Medical Department of a central teaching hospital in an urban area. We performed a retrospective observational study of patients admitted consecutively to the Medical Department via the emergency room between January and June 2001. Discharge casenotes on 1038 admissions were reviewed. Those with a diagnosis of HF or cardiovascular conditions associated with or precursors of HF were analyzed. Cases with a final diagnosis of HF according to the criteria of the ESC guidelines were included in the study. We evaluated the overall prevalence of HF and subtypes of cardiac dysfunction, etiological risk factors, patients' demographic characteristics, decompensating factors, comorbidity, mean length of hospital stay, and in-hospital mortality rate. We identified 180 patients with HF (17.4%), mean age 74.6 +/- 14; 87 were male (48%), aged 73.7 +/- 14.2, and 93 female (52%), aged 75.6 +/- 14. Left ventricular systolic dysfunction (LVSD) was present in 42.2% of cases, preserved left ventricular systolic function in 32.6%, and valvular heart disease in 10.6%. Hypertension and coronary artery disease were the main etiological risk factors (62.2% and 42.8% respectively). Atrial fibrillation was recorded in 43.4% of the patients, diabetes was diagnosed in 21.6%, and anemia and chronic obstructive pulmonary disease in about one third. Infection, predominantly

  2. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs...... and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality...

  3. Low literacy self-care management patient education for a multi-lingual heart failure population: Results of a pilot study.

    Science.gov (United States)

    Dickson, Victoria Vaughan; Chyun, Deborah; Caridi, Cristina; Gregory, Jill K; Katz, Stuart

    2016-02-01

    The purpose of this pilot study was to test the impact of language-free, low literacy self-care management patient education materials in an ethnically diverse multilingual heart failure (HF) population. A one group pre-test-post-test design measured changes in self-care, knowledge and health-related quality of life (HRQL) after a 1 month intervention using language-free, low literacy self-care management patient education materials and delivered by a health educator. The ethnically diverse sample (n=21) was predominately male (72%), 48% Black, 42% Hispanic, and 28% marginal/inadequate literacy. There were significant improvements in self-care and knowledge but not HRQL. Language-free, low literacy self-care patient education may facilitate improved self-care and knowledge in diverse populations who are at risk for poor HF outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Ultrasound for critical care physicians: now my heart is still somewhat full

    Directory of Open Access Journals (Sweden)

    Chan K

    2016-06-01

    Full Text Available No abstract available. Article truncated after first page. A 48-year-old man with a history of hypertension, intravenous drug abuse, hepatitis C, and cirrhosis presented with 1 day of melena and hematemesis. While in the Emergency Department, the patient was witnessed to have approximately 700 mL of hematemesis with tachycardia and hypotension. The patient was admitted to the Medical Intensive Care Unit for hypotension secondary to acute blood loss. He was found to have a decreased hemoglobin, elevated international normalized ratio (INR, and sinus tachycardia. A bedside echocardiogram was performed. What is the best explanation for the echocardiographic findings shown above? 1. Atrial Fibrillation ; 2.\tAtrial Myxoma; 3. Cardiac Lymphoma; 4. Tricuspid Valve Endocarditis; 5. Tumor Thrombus ...

  5. The European Union – Caribbean Relation

    DEFF Research Database (Denmark)

    Broberg, Morten

    2016-01-01

    EU diplomats consider the Caribbean countries to be allies and therefore expect these countries to support the EU in international affairs – but they find that this support has been waning in recent years. Caribbean diplomats and politicians do not share the European viewpoint. Rather, they take ...... the view that the EU has forgotten its Caribbean allies and instead channels its attention and funding towards Sub-Saharan Africa. This article examines to what extent this asserted ‘rift’ really signals a profound change in the EU-Caribbean relations....

  6. Brian Meeks, Envisioning Caribbean Futures

    Directory of Open Access Journals (Sweden)

    Jay R. Mandle

    2011-06-01

    Full Text Available In this feature we highlight a recently launched book. We invite specialists in the field to comment on the book, and we invite the author to respond to their comments. In this issue we focus on Brian Meeks's, Envisioning Caribbean Futures. Those invited to comment on the book are Jay Mandle and Rivke Jaffe. [First paragraph] In Envisioning Caribbean Futures: Jamaican Perspectives (2007, Brian Meeks writes “in sympathy with the new social movements that have evolved in the past decade which assert boldly that ‘another world is possible’” (p. 2. His effort is “to explore the horizons for different approaches to social living in Jamaica and the Caribbean in the twenty-first century” (p. 2. In this, he “seeks to move beyond a statement of general principles to propose specific alternatives” in order to “stimulate a conversation that looks beyond the horizon of policy confines, yet is not so far removed as to appear hopelessly utopian” (p. 3. My hope with this essay is to advance that conversation, in the first place by reviewing and assessing Meeks’s contribution and then by extending the discussion to the role that Jamaica’s diaspora (and by extension that of the region’s generally might play in moving the country, as Meeks puts it, from its current “state of crime and murder, and the broad undermining of the rule of law that pervades the society” (p. 71.

  7. Echo and BNP serial assessment in ambulatory heart failure care: Data on loop diuretic use and renal function.

    Science.gov (United States)

    Dini, Frank Lloyd; Simioniuc, Anca; Carluccio, Erberto; Ghio, Stefano; Rossi, Andrea; Biagioli, Paolo; Reboldi, Gianpaolo; Galeotti, Gian Giacomo; Lu, Fei; Zara, Cornelia; Whalley, Gillian; Temporelli, Pier Luigi

    2016-12-01

    We compared the follow-up data on loop diuretic use and renal function, as assessed by serum creatinine levels, and the estimated glomerular filtration rate (eGFR), of two groups of consecutive ambulatory HF patients: 1) the clinically-guided group, in which management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department of Pisa (standard of care) and 2) the echo and B-type natriuretic peptide (BNP) guided group (patients conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group: Pisa, Perugia, Pavia; Verona, Auckland, and Veruno), in which therapy was delivered according to the serial assessment of BNP and echocardiography. Patients whose follow-up was based on standard of care had a significant higher prevalence of worsening renal function, that was likely related to higher diuretic dosages, whilst, a better management of renal function was observed in the echo-BNP-guided group. The data is related to "Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients" (A. Simioniuc, E. Carluccio, S. Ghio, A. Rossi, P. Biagioli, G. Reboldi, G.G. Galeotti, F. Lu, C. Zara, G. Whalley, P.G. Temporelli, F.L. Dini, 2016; K.J. Harjai, H.K. Dinshaw, E. Nunez, M. Shah, H. Thompson, T. Turgut, H.O. Ventura, 1999; A. Ahmed, A. Husain, T.E. Love, G. Gambassi, L.J. Dell׳Italia, G.S. Francis, M. Gheorghiade, R.M. Allman, S. Meleth, R.C. Bourge, 2006) [1], [2], [3].

  8. Echo and BNP serial assessment in ambulatory heart failure care: Data on loop diuretic use and renal function

    Directory of Open Access Journals (Sweden)

    Frank Lloyd Dini

    2016-12-01

    Full Text Available We compared the follow-up data on loop diuretic use and renal function, as assessed by serum creatinine levels, and the estimated glomerular filtration rate (eGFR, of two groups of consecutive ambulatory HF patients: 1 the clinically-guided group, in which management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department of Pisa (standard of care and 2 the echo and B-type natriuretic peptide (BNP guided group (patients conforming to the protocol of the Network Labs Ultrasound (NEBULA in HF Study Group: Pisa, Perugia, Pavia; Verona, Auckland, and Veruno, in which therapy was delivered according to the serial assessment of BNP and echocardiography. Patients whose follow-up was based on standard of care had a significant higher prevalence of worsening renal function, that was likely related to higher diuretic dosages, whilst, a better management of renal function was observed in the echo-BNP-guided group. The data is related to “Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients” (A. Simioniuc, E. Carluccio, S. Ghio, A. Rossi, P. Biagioli, G. Reboldi, G.G. Galeotti, F. Lu, C. Zara, G. Whalley, P.G. Temporelli, F.L. Dini, 2016; K.J. Harjai, H.K. Dinshaw, E. Nunez, M. Shah, H. Thompson, T. Turgut, H.O. Ventura, 1999; A. Ahmed, A. Husain, T.E. Love, G. Gambassi, L.J. Dell׳Italia, G.S. Francis, M. Gheorghiade, R.M. Allman, S. Meleth, R.C. Bourge, 2006 [1–3].

  9. Time Interval from Symptom Onset to Hospital Care in Patients with Acute Heart Failure: A Report from the Tokyo Cardiac Care Unit Network Emergency Medical Service Database.

    Directory of Open Access Journals (Sweden)

    Yasuyuki Shiraishi

    Full Text Available There seems to be two distinct patterns in the presentation of acute heart failure (AHF patients; early- vs. gradual-onset. However, whether time-dependent relationship exists in outcomes of patients with AHF remains unclear.The Tokyo Cardiac Care Unit Network Database prospectively collects information of emergency admissions via EMS service to acute cardiac care facilities from 67 participating hospitals in the Tokyo metropolitan area. Between 2009 and 2011, a total of 3811 AHF patients were registered. The documentation of symptom onset time was mandated by the on-site ambulance team. We divided the patients into two groups according to the median onset-to-hospitalization (OH time for those patients (2h; early- (presenting ≤2h after symptom onset vs. gradual-onset (late group (>2h. The primary outcome was in-hospital mortality.The early OH group had more urgent presentation, as demonstrated by a higher systolic blood pressure (SBP, respiratory rate, and higher incidence of pulmonary congestion (48.6% vs. 41.6%; P<0.001; whereas medical comorbidities such as stroke (10.8% vs. 7.9%; P<0.001 and atrial fibrillation (30.0% vs. 26.0%; P<0.001 were more frequently seen in the late OH group. Overall, 242 (6.5% patients died during hospitalization. Notably, a shorter OH time was associated with a better in-hospital mortality rate (odds ratio, 0.71; 95% confidence interval, 0.51-0.99; P = 0.043.Early-onset patients had rather typical AHF presentations (e.g., higher SBP or pulmonary congestion but had a better in-hospital outcome compared to gradual-onset patients.

  10. Time Interval from Symptom Onset to Hospital Care in Patients with Acute Heart Failure: A Report from the Tokyo Cardiac Care Unit Network Emergency Medical Service Database.

    Science.gov (United States)

    Shiraishi, Yasuyuki; Kohsaka, Shun; Harada, Kazumasa; Sakai, Tetsuro; Takagi, Atsutoshi; Miyamoto, Takamichi; Iida, Kiyoshi; Tanimoto, Shuzou; Fukuda, Keiichi; Nagao, Ken; Sato, Naoki; Takayama, Morimasa

    2015-01-01

    There seems to be two distinct patterns in the presentation of acute heart failure (AHF) patients; early- vs. gradual-onset. However, whether time-dependent relationship exists in outcomes of patients with AHF remains unclear. The Tokyo Cardiac Care Unit Network Database prospectively collects information of emergency admissions via EMS service to acute cardiac care facilities from 67 participating hospitals in the Tokyo metropolitan area. Between 2009 and 2011, a total of 3811 AHF patients were registered. The documentation of symptom onset time was mandated by the on-site ambulance team. We divided the patients into two groups according to the median onset-to-hospitalization (OH) time for those patients (2h); early- (presenting ≤2h after symptom onset) vs. gradual-onset (late) group (>2h). The primary outcome was in-hospital mortality. The early OH group had more urgent presentation, as demonstrated by a higher systolic blood pressure (SBP), respiratory rate, and higher incidence of pulmonary congestion (48.6% vs. 41.6%; P<0.001); whereas medical comorbidities such as stroke (10.8% vs. 7.9%; P<0.001) and atrial fibrillation (30.0% vs. 26.0%; P<0.001) were more frequently seen in the late OH group. Overall, 242 (6.5%) patients died during hospitalization. Notably, a shorter OH time was associated with a better in-hospital mortality rate (odds ratio, 0.71; 95% confidence interval, 0.51-0.99; P = 0.043). Early-onset patients had rather typical AHF presentations (e.g., higher SBP or pulmonary congestion) but had a better in-hospital outcome compared to gradual-onset patients.

  11. Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD).

    Science.gov (United States)

    Sillman, Christina; Morin, Joanne; Thomet, Corina; Barber, Deena; Mizuno, Yoshiko; Yang, Hsiao-Ling; Malpas, Theresa; Flocco, Serena Francesca; Finlay, Clare; Chen, Chi-Wen; Balon, Yvonne; Fernandes, Susan M

    2017-02-15

    Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  12. Perceived self-efficacy, personality and bioethics before a heart rehabilitation programme in primary health care.

    Science.gov (United States)

    Madueño Caro, Antonio J; Mellado Fernández, Manuel Luis; Delgado Pacheco, Juana; Muñoz Ayllon, Marta; Pardos Lafarga, Manuel; Saez García, Laura

    There is a clear evidence of the benefit of cardiac rehabilitation after a cardiovascular event on patients' mood and perceived self-efficacy in terms of their own health care. Our aim is to define the correlation between mood-related variables, biotype and self-efficacy in this population. Descriptive study. The entire population of patients discharged from thecardiac rehabilitation unit over 12 months. Universal anthropometric and psychometric (general self-efficacy scale, Salamanca personality traits questionnaire, Hamilton anxiety scale and Beck depression inventory) variables are determined. Descriptive statistics and association between variables (correlation) is determined. This study involved 88 patients, response rate 92%. The average age was 53 years old, 80.23% were males. Descriptive statistics and Pearson correlations for the main dependent variable and associated variables is performed. Significant evidence is shown, self-efficacy is negatively correlated with anxiety (r=-0.4009) and depression (r=-0.4152), as well as dependent(r=-03 175) and impulsive (r=-0.4243) personality traits. Higher levels of anxiety positively correlate with endomorph biotype (r=0.3304), and depression-associated symptoms (r=0.2563). Age and gender do not correlate with self-perceived efficacy. Self-efficacy in the study population is correlated with personality traits, mood and body biotype. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  13. Effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure: a randomised controlled trial.

    Science.gov (United States)

    Wang, Tzu-Chieh; Huang, Jin-Long; Ho, Wen-Chao; Chiou, Ai-Fu

    2016-04-01

    Fatigue is a common symptom in patients with heart failure that is easy to ignore. In addition, fatigue may affect patients' physical function and psychosocial conditions that can impair their quality of life. An effective nursing care programme is required to alleviate patients' fatigue and improve their quality of life. To investigate the effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure. A randomised controlled trial design was used. Ninety-two patients with heart failure were randomly assigned to an intervention group (n=47) or a control group (n=45). The patients in the intervention group participated in 12 weeks of a supportive educational nursing care programme including fatigue assessment, education, coaching self-care and evaluation. The intervention was conducted by a cardiac nurse during four face-to-face interviews and three follow-up telephone interviews. Fatigue and quality of life were assessed at the baseline and 4 weeks, 8 weeks and 12 weeks after enrollment in both groups. The participants in the intervention group exhibited a significant decrease in the level of fatigue after 12 weeks, whereas those in the control group exhibited no significant changes. Compared with the control group, the intervention group exhibited a significantly greater decrease in the level of fatigue and significantly greater improvement in quality of life after 12 weeks of intervention. The supportive educational nursing care programme was recommended to alleviate fatigue and improve quality of life in patients with heart failure. © The European Society of Cardiology 2015.

  14. The feasibility of a telecommunications service in support of outpatient congestive heart failure care in a diverse patient population.

    Science.gov (United States)

    Nanevicz, T; Piette, J; Zipkin, D; Serlin, M; Ennis, S; De Marco, T; Modin, G

    2000-01-01

    A home telemonitoring system for patients with congestive heart failure was studied for feasibility and efficacy in a diverse patient population. Fifty patients used the service, in which they weighed themselves and answered yes/no questions about symptoms. Changes in patient weights or symptoms prompted a nurse to call the patient and/or the physician. Patients were given educational and quality of life surveys at enrollment, at 30 days, and at 6 months. The average daily usage rate was 94%. Patients were contacted 57 times--prompting 57 physician notifications, eight medication changes, and 11 nonroutine clinic visits. Patient response to lifestyle surveys showed an improvement in quality of life and improved understanding of prevention measures. Eighty-four percent of patients and 65% of physicians reported satisfaction with the system. This pilot study suggests that home telemonitoring is feasible and has clinical utility in diverse patient groups, and may improve patients' satisfaction and knowledge of self-care. (c)2000 by CHF, Inc.

  15. [Diagnostic and therapeutic methods for perioperative children with congenital heart disease with airway stenosis in pediatric intensive care unit].

    Science.gov (United States)

    Xu, Xuan; Liu, Xi-cheng; Li, Dan-dan; Zhu, Bin; Xiao, Li-jun; Feng, Zhi-chun; Zhu, Yi-min

    2013-11-01

    To explore the diagnostic and therapeutic methods for perioperative children with congenital heart disease (CHD) with airway stenosis in pediatric intensive care unit (PICU). Fiberoptic bronchoscopy was used for the diagnosis of 100 CHD cases in PICU who were clinically considered to have possible airway malformation because of complicated difficult-to-control lung infection, atelectasis and failure with the ventilator after surgery from January 2010 to October 2011. Cases who were confirmed to have severe airway stenosis by bronchoscopy and weaning from the ventilator after surgery were treated with balloon expandable stents into the desired position in the bronchoscopy. There were 73 cases (73%) of CHD patients with airway abnormalities, including 31 cases of severe stenosis (31%), moderate stenosis in 29 cases (29%), mild stenosis in 13 cases (13%). Nine of the 10 children in whom the mechanical ventilation was hard to be stopped after surgery because of severe airway stenosis were weaned from mechanical ventilation successfully by fiberoptic bronchoscopy, while one case died from primary disease with severe sepsis after the placement of bronchial stents. CHD children with difficult-to-control lung infection, atelectasis and failure with ventilator after surgery are often complicated with airway abnormalities. The therapeutic bronchoscopy with airway stent can be used for cases with weaning from the ventilator because of severe airway stenosis.

  16. Effect of family nursing therapeutic conversations on health-related quality of life, self-care and depression among outpatients with heart failure

    DEFF Research Database (Denmark)

    Østergaard, Birte; Mahrer-Imhof, Romy; Wagner, Lis

    2018-01-01

    Objective: To evaluate the short-term (3 months) effects of family nursing therapeutic conversations (FNTC) on health-related quality of life, self-care and depression in outpatients with Heart failure (HF). Methods: A randomised multi-centre trial was conducted in three Danish HF clinics....... The control group (n = 167) received usual care, and the intervention group (n = 180) received FNTCs as supplement to usual care. Primary outcome was clinically significant changes (6 points) in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score between groups. Secondary outcomes were changes...... in self-care behaviour and depression scores. Data were assessed before first consultation and repeated after three months. Results: No statistically significant difference was found in the change of KCCQ, self-care and depression scores between the groups. KCCQ scores of patients in the FNTC group...

  17. Educational health disparities in hypertension and diabetes mellitus among African descent populations in the Caribbean and the USA: a comparative analysis from the Spanish town cohort (Jamaica) and the Jackson heart study (USA).

    Science.gov (United States)

    Bidulescu, Aurelian; Ferguson, Trevor S; Hambleton, Ian; Younger-Coleman, Novie; Francis, Damian; Bennett, Nadia; Griswold, Michael; Fox, Ervin; MacLeish, Marlene; Wilks, Rainford; Harris, E Nigel; Sullivan, Louis W

    2017-02-14

    Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries. We analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as 'less than high school' (HS). Educational disparities in the prevalence of hypertension and diabetes were examined using prevalence ratios (PR), controlling for age, sex and body mass index (BMI). Analyses included 7248 participants, 2382 from STC and 4866 from JHS, with mean age of 47 and 54 years, respectively (p education level for both hypertension and diabetes in both studies; however, after accounting for confounding or interaction by age, sex and BMI these effects were attenuated. For hypertension, after adjusting for age and BMI, a significant education disparity was found only for women in JHS, with PR of 1.10 (95% CI 1.04-1.16) for  HS and 1.07 (95% CI 1.01-1.13) for HS vs > HS. For diabetes; when considering age-group and sex specific estimates adjusted for BMI, among men: significant associations were seen only in the 45-59 years age-group in JHS with PR 1.84 (95% CI 1.16-2.91) for  HS. Among women, significant PR comparing  HS was seen for all three age-groups for JHS, but not in STC; PR were 3.95 (95% CI 1.94-8.05), 1.53 (95% CI 1.10-2.11) and 1.32 (95% CI 1.06-1.64) for 25-44, 45-59 and 60-74 age-groups, respectively. In Jamaica, educational disparities were largely explained by age, sex and BMI, while in the USA these disparities were larger and persisted after accounting these variables.

  18. Comparing the ambulatory care and outcomes for rural and urban patients with chronic ischemic heart disease: a population-based cohort study.

    Science.gov (United States)

    Tran, Christopher; Wijeysundera, Harindra C; Qui, Feng; Tu, Jack V; Bhatia, R Sacha

    2014-11-01

    Little is known about variations in the quality of ambulatory care between urban and rural communities for patients with stable ischemic heart disease. The objectives of this study were to understand the effect of rurality on variations of ambulatory processes of care and outcomes for patients with stable ischemic heart disease. A population-based cohort study was conducted, which included all Ontario patients with stable ischemic heart disease confirmed on cardiac catheterization between October 1, 2008, and September 30, 2011. Patients were categorized as rural or urban based on the Rurality Index for Ontario score. Ambulatory processes of care of interest were diagnostic testing, medication usage, and access to general/speciality physicians over a 1-year time-horizon. Primary outcome was 1-year mortality. Secondary outcomes included 1-year myocardial infarction, repeat cardiac/all-cause hospitalization, and emergency department visits. The cohort consisted of 38 804 patients, of whom 34 949 (90%) were urban and 3855 (10%) were rural patients. After risk-adjustment, rural patients had lower rates of cholesterol assessment (odds ratios 0.41; 95% confidence interval [CI], 0.38-0.44; Purban patients. Rural patients had fewer total ambulatory physician visits (rate ratio 0.76; 95% CI, 0.75-0.78; Pcare (0.76; 95% CI, 0.74-0.78; Prural patients (odds ratios 1.82; 95% CI, 1.70-1.96; Pcare between urban and rural patients with stable ischemic heart disease, there were no outcome differences. © 2014 American Heart Association, Inc.

  19. Long-term effect of cardiac resynchronisation in patients reporting mild symptoms of heart failure: a report from the CARE-HF study.

    Science.gov (United States)

    Cleland, J G F; Freemantle, N; Daubert, J-C; Toff, W D; Leisch, F; Tavazzi, L

    2008-03-01

    Cardiac resynchronisation therapy (CRT) improves symptoms and prognosis in patients with heart failure and cardiac dyssynchrony. Guidelines from the National Institute of Health and Clinical Excellence in the United Kingdom recommend CRT for patients with recent or persistent moderate or severe symptoms of heart failure. This analysis investigated whether the severity of symptoms was an important determinant of the prognostic benefits of CRT. In CARE-HF, patients with left ventricular ejection fraction Heart Association (NYHA) class III/IV were randomly assigned to pharmacological treatment alone or with addition of CRT. This analysis investigated whether the severity of symptoms reported by patients, using Likert Scales from the EuroHeart Failure Questionnaire and self-assessed NYHA class, influenced prognosis and the response to CRT. Of 813 patients, 175 (21.5%) assessed themselves to be in NYHA class I or II. These patients also reported less severe symptoms and better quality of life than patients who assessed themselves to be in NYHA class III or IV. No statistical interaction was observed between the severity of symptoms assessed in several ways and the benefits of CRT on morbidity and mortality. The severity of symptoms was not an important determinant of the prognostic effects of CRT in patients with moderate or severe LVSD and markers of dyssynchrony in the CARE-HF study. This finding requires confirmation in an adequately powered prospective randomised controlled trial in patients with milder symptoms.

  20. The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: a quasi-experimental study.

    Science.gov (United States)

    Chiang, Li-Chi; Chen, Wan-Chou; Dai, Yu-Tzu; Ho, Yi-Lwun

    2012-10-01

    Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home. To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only. This is a quasi-experimental study design. Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients' health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group×time interaction were analysed using Mixed Model in SPSS (17.0). Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function

  1. Patient education in chronic heart failure in primary care (ETIC) and its impact on patient quality of life: design of a cluster randomised trial.

    Science.gov (United States)

    Vaillant-Roussel, Hélène; Laporte, Catherine; Pereira, Bruno; Tanguy, Gilles; Cassagnes, Jean; Ruivard, Marc; Clément, Gilles; Le Reste, Jean-Yves; Lebeau, Jean-Pierre; Chenot, Jean-François; Pouchain, Denis; Dubray, Claude; Vorilhon, Philippe

    2014-12-24

    Chronic heart failure, is increasing due to the aging population and improvements in heart disease detection and management. The prevalence is estimated at ~10% of the French general practice patient population over 59 years old. The primary objective of this study is to improve the quality of life for heart failure patients though a complex intervention involving patient and general practitioner (GP) education in primary care. A randomised, cluster controlled trial, stratified over 4 areas of the Auvergne region in France comparing intervention and control groups. The inclusion criteria are: patients older than 50 years with New York Heart Association (NYHA) stage I, II, or III heart failure, with reduced ejection fraction or with preserved ejection fraction. Heart failure should be confirmed by the patient's cardiologist according to the European Society of Cardiology guidelines criteria. The exclusion criteria include: severe cognitive disorders, living in an institution, participating in another clinical trial, having NYHA stage IV heart failure, or a lack of French language skills. The complex intervention consists of training at the GP practice with an interactive 2-day workshop to provide a patient's education programme. GPs are trained to perform case management, lifestyle counselling and motivational interviewing, to educate patients on the main topics including clinical alarm signs, physical activity, diet and cardiovascular risk factors. The patients' education sessions are scheduled at 1, 4, 7, 10, 13 and 19 months following the start of the trial. The primary outcome to be assessed is the impact on the quality of life as determined using two questionnaires: the Minnesota Living with Heart Failure Questionnaire and SF-36. To detect a difference in the mean quality of life at 19 months, we anticipate studying a minimum of 400 patients from 80 GPs. This trial will provide insight into the effectiveness of a complex intervention to educate patients with

  2. Cross-cultural adaptation and validation of the European Heart Failure Self-care Behavior Scale for Brazilian Portuguese Adaptación transcultural y validación de la European Heart Failure Self-care Behavior Scale para el Portugués de Brasil Adaptação transcultural e validação da European Heart Failure Self-care Behavior Scale para o português do Brasil

    Directory of Open Access Journals (Sweden)

    Maria Karolina Feijó

    2012-10-01

    Full Text Available OBJECTIVE: To adapt and validate a Brazilian Portuguese version of the European Heart Failure Self-Care Behavior Scale. METHODS: The cross-cultural adaptation (translation, synthesis, back-translation, expert committee review, and pretesting and validation (assessment of face validity, content validity, and internal consistency reliability were carried out in accordance with the literature. The European Heart Failure Self-Care Behavior Scale assesses key components of self-care: recognition of the signs and symptoms of decompensated heart failure (HF and decision-making when these signs and symptoms arise. It comprises 12 items (range 12-60, where lower scores indicate better self-care. RESULTS: The sample comprised 124 HF patients with a mean age of 62.3 ± 12 years. The Cronbach's Alpha internal consistency was 0.70 and the intraclass correlation coefficient for reproducibility was 0.87. CONCLUSION: Face and content validity, internal consistency and reproducibility have lended validity and reliability for the use of the instrument in Brazil.OBJETIVO: Adaptar y validar European Heart Failure Self-Care Behavior Scale para uso en lengua portuguesa de Brasil. MÉTODOS: El proceso de adaptación cultural (traducción, síntesis, retro traducción, revisión por comité de expertos y pré test, validación (validez de facie, de contenido y confiabilidad fue realizado según la literatura. La European Heart Failure Self-Care Behavior Scale evalúa los componentes-clave para el auto cuidado: reconocimiento de señales y síntomas de descompensación de insuficiencia cardiaca (IC y la decisión cuando ocurren dichos síntomas. Se compone de 12 cuestiones (que van desde 12-60, en donde las puntuaciones bajas indican peor autocuidado. RESULTADOS: Fueron inclusos 124 pacientes con IC, con edad entre 62,3 ±12 años. La consistencia interna de las cuestiones presentó un Alfa de Cronbach de 0,70 y la reproducibilidad evaluada por el coeficiente de

  3. Heart murmurs

    Science.gov (United States)

    Chest sounds - murmurs; Heart sounds - abnormal; Murmur - innocent; Innocent murmur; Systolic heart murmur; Diastolic heart murmur ... The heart has 4 chambers: Two upper chambers (atria) Two lower chambers (ventricles) The heart has valves that close ...

  4. Teaching and Learning with Caribbean Students.

    Science.gov (United States)

    London, Clement B. G.

    Presently, the most frequent point of contact between the United States and many Caribbean island states is the immigrant population. Incentives for immigration are provided by a tradition of colonialism, economies dependent upon agriculture, and problems resulting from rapidly increasing populations. The continuing influx of Caribbeans to the…

  5. Cross-Cultural Adaptation and Psychometric Testing of the Brazilian Version of the Self-Care of Heart Failure Index Version 6.2

    Science.gov (United States)

    Ávila, Christiane Wahast; Riegel, Barbara; Pokorski, Simoni Chiarelli; Camey, Suzi; Silveira, Luana Claudia Jacoby; Rabelo-Silva, Eneida Rejane

    2013-01-01

    Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = −0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties. PMID:24163765

  6. Uncovering heart failure with preserved ejection fraction in patients with type 2 diabetes in primary care : Time for a change

    NARCIS (Netherlands)

    Boonman-de Winter, L. J M; Cramer, M. J.; Hoes, A. W.; Rutten, F. H.

    2016-01-01

    Undetected heart failure appears to be an important health problem in patients with type 2 diabetes and aged ≥ 60 years. The prevalence of previously unknown heart failure in these patients is high, steeply rises with age, and is overall higher in women than in men. The majority of the patients with

  7. Comorbid Mental Health Symptoms and Heart Diseases: Can Health Care and Mental Health Care Professionals Collaboratively Improve the Assessment and Management?

    Science.gov (United States)

    Ai, Amy L.; Rollman, Bruce L.; Berger, Candyce S.

    2010-01-01

    On the basis of current epidemiological and clinical research, this article describes how mental health symptoms are associated with heart disease, a major chronic condition that occurs primarily in middle and late life. The article describes the culturally and historically important link between heart and mind. It then describes depression and…

  8. Socioeconomic status and prevalence of congenital heart defects: does universal access to health care system eliminate the gap?

    Science.gov (United States)

    Agha, Mohammad M; Glazier, Richard H; Moineddin, Rahim; Moore, Aideen M; Guttmann, Astrid

    2011-12-01

    A twofold increase in the prevalence of congenital heart defects (CHDs) has been reported since the early 1970s with higher rates among children from low socioeconomic status (SES). This increase and the observed SES gap are postulated to be reflective of higher ascertainment, especially increased use of ultrasound and echography. The purpose of this study was to examine if trends over time in the prevalence of CHD were the same for high and low SES groups. Using the child's health number as a unique identifier and through record linkage, children born in Ontario between 1994 and 2007 were followed for the diagnosis of CHD. Using postal codes and census information, SES quintiles were assigned to each child. We used adjusted rates and used multivariate models to compare trends in the prevalence rate among children born in different SES groups. Children born in low SES areas (23% of all births) had significantly higher rates of CHDs (rate ratio = 1.20; 95% confidence interval [CI] = 1.15-1.24). While prevalence of nonsevere CHDs declined in all SES groups since 2000, severe CHDs, especially atrial septal defects were on the rise during the study period. It is assumed that increased ascertainment is responsible for observed increase in the prevalence of CHD, especially minor defects. While the trend and pattern over time changed for severe and nonsevere CHDs, the SES gap remained consistent during the study period. Our results indicate that even free and universal access to a health care system does not eliminate the SES gap observed in the prevalence of CHD. Copyright © 2011 Wiley Periodicals, Inc.

  9. A systematic review of the effectiveness of current interventions to assist adults with heart failure to comply with therapy and enhance self-care behaviours.

    Science.gov (United States)

    Kent, Bridie; Cull, Emily; Phillips, Nicole M

    2011-01-01

    Heart failure is a common chronic disease that is one of the leading causes of hospitalisations in many countries around the world. Poor compliance with recommended self-care behaviours, for example managing medication and diet regimes, rather than the deterioration of the cardiac condition, have contributed to a significant proportion of heart failure exacerbations. Patients with heart failure can benefit from interventions that aim to increase their knowledge of the disease and support them in managing their care. There is a need, however, to determine which interventions, if any, are more effective in achieving the aims of self-care. This review examined the evidence to answer the question: What are the most effective interventions for helping adults with heart failure comply with therapy and enhance self care behaviours? This review focused on adults (aged 18 years and over) diagnosed with heart failure.The review considered studies that evaluated interventions aimed to help people with heart failure to improve self-care behaviours.Randomised control trials, quasi-randomised designs and pre-test post-test studies were included in the review.The primary outcome measure was improvement in actual self-care behaviours, including adherence to medications, maintaining a healthy diet, daily weighing, reducing salt intake, recognising symptoms and contacting health professionals when assistance may be required. The search sought to identify published and unpublished, English language studies from 1990 until 2010. Databases searched included Medline, EMBASE, CINAHL, PsycInfo, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews & JBI COnNECT, PubMed, Informit - Health Collection, MEDNAR, Dissertations & Theses, and Google Scholar METHODOLOGICAL QUALITY: Two independent reviewers independently used the standard critical appraisal tool, from the Joanna Briggs Institute, to assess the methodological quality of studies that matched with inclusion criteria

  10. Cancer burden in Latin America and the Caribbean.

    Science.gov (United States)

    Curado, Maria Paula; de Souza, Dyego Leandro Bezerra

    2014-01-01

    In Latin America and the Caribbean, the epidemiological transition has been occurring in an unequal manner. Infectious-contagious diseases share space with the increase of chronic nontransmissible diseases, such as cancer, which already represents the second most common cause of death, after cardiovascular illnesses. This study provides a global picture of the burden of cancer in Latin America and the Caribbean, as well as the challenges faced when controlling this disease in these regions. Epidemiological information on cancer in Latin America originates mainly from mortality registries and from a limited number of population-based cancer registries. Estimates indicate increases of 72% in the incidence of cancer and 78% in the mortality of men between 2012 and 2030, and for women the rates are 62% and 74%, respectively. These increases in incidence rates, accompanied by disproportionally high mortality rates, when compared with other regions of the world, reveal the magnitude of the challenge of controlling cancer in Latin America and the Caribbean. Although neoplasms are among the main causes of death, the control strategies are faced with issues such as organization and development of the health system, and the public policy formulation mechanism. Establishing knowledge on the real impact of incidence, mortality, and survival in Latin America and the Caribbean is quite a challenge due to the lack of an updated and dynamic information system on mortality and incidence, although some improvement has been made in the information systems of some countries within the most recent decade. Other obstacles for cancer control are the uneven allocation of resources, lack of investments in equipment and infrastructure, and the concentration of health care professionals in large urban centers, which contribute to the reproduction of socioeconomic iniquities in the assistance of populations that suffer from cancer. Copyright © 2014 Icahn School of Medicine at Mount Sinai

  11. Health Literacy and the Patient With Heart Failure-Implications for Patient Care and Research: A Consensus Statement of the Heart Failure Society of America

    OpenAIRE

    Evangelista, LS; Rasmusson, KD; Laramee, AS; Barr, J; Ammon, SE; Dunbar, S; Ziesche, S; Patterson, JH; Yancy, CW

    2010-01-01

    Background: Low health literacy compromises patient safety, quality health care, and desired health outcomes. Specifically, low health literacy is associated with decreased knowledge of one's medical condition, poor medication recall, nonadherence to treatment plans, poor self-care behaviors, compromised physical and mental health, greater risk of hospitalization, and increased mortality. Methods: The health literacy literature was reviewed for: definitions, scope, risk factors, assessment, i...

  12. Fetal Heart Rate Monitoring during Labor

    Science.gov (United States)

    f AQ FREQUENTLY ASKED QUESTIONS FAQ015 LABOR, DELIVERY, AND POSTPARTUM CARE Fetal Heart Rate Monitoring During Labor • What is fetal heart rate monitoring? • Why is fetal heart rate monitoring ...

  13. Pediatric Heart Failure, Lagging, and Sagging of Care in Low Income Settings: A Hospital Based Review of Cases in Ethiopia

    Directory of Open Access Journals (Sweden)

    Solmon Gebremariam

    2016-01-01

    Full Text Available Introduction. Causes of acute heart failure in children range from simple myocarditis complicating chest infection to complex structural heart diseases. Objective. To describe patterns, predictors of mortality, and management outcomes of acute heart failure in children. Methods. In retrospective review, between February 2012 and October 2015 at a tertiary center, 106 admitted cases were selected consecutively from discharge records. Data were extracted from patients chart and analyzed using SPSS software package. t-test and statistical significance at P value < 0.05 with 95% CI were used. Result. Acute heart failure accounted for 2.9% of the total pediatric admissions. The age ranged from 2 months up to 14 years with mean age of 8 years. Male to female ratio is 1 : 2.1. Rheumatic heart disease accounted for 53.7%; pneumonia, anemia, infective endocarditis, and recurrence of acute rheumatic fever were the main precipitating causes. Death occurred in 19% of cases. Younger age at presentation, low hemoglobin concentration, and undernutrition were associated with death with P value of 0.00, 0.01, and 0.02, respectively. Conclusions and Recommendation. Pediatric heart failure in our settings is diagnosed mainly in older age groups and mostly precipitated due to preventable causes. Significant mortality is observed in relation to factors that can be preventable in children with underlying structural heart disease. Early suspicion and diagnosis of cases may reduce the observed high mortality.

  14. Critical pathway for the management of acute heart failure at the Veterans Affairs San Diego Healthcare System: transforming performance measures into cardiac care.

    Science.gov (United States)

    Gardetto, Nancy J; Greaney, Karen; Arai, Lisa; Brenner, April; Carroll, Karen C; Howerton, Nancy M; Lee, Melinda; Pada, Laureen; Tseng, Marilynne; Maisel, Alan S

    2008-09-01

    Acute decompensated heart failure (ADHF) is a major public health problem and leading cause for hospitalization in people 65 years and older. Admission rates for ADHF, accounted for more than 1 million heart failure (HF) hospitalizations in 2004, and more than 6.5 million inpatient hospital days. Despite significant advances in HF management, including pharmacotherapy and devices; and extensive collaborative efforts of the American College of Cardiology, and American Heart Association to disseminate evidence-based practice guidelines for management of chronic HF in adults; 3 patients continue to present to the emergency departments in ADHF. The hospital treatment of HF frequently does not follow published guidelines, potentially contributing to the high morbidity, mortality, and economic cost of this disorder. This highlights an ongoing need for development of quality improvement programs that focus on delivering reliable, evidence-based care for patients with ADHF. Consequently, the development of clinical pathways has the potential to reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. The Veterans Affairs San Diego Healthcare System (VASDHCS) formed a multidisciplinary HF performance improvement team. The team set forth on the task of developing standard order sets for patients with ADHF. After analyzing local care processes, reviewing evidence of best care practices, and defining appropriate goals to satisfy the multidimensional needs of HF patient; the team developed a computerized pathway in a user-friendly format that is simple, yet comprehensive; and focuses on early stages of HF evaluation and treatment for patients presenting to the emergency department. Successful strategies to improve care for HF patients need to assist health care providers with rapid recognition and early aggressive treatment, while creating a reliable process that ensures continuity of care. This critical pathway for management of

  15. A qualitative meta-summary using Sandelowski and Barroso's method for integrating qualitative research to explore barriers and facilitators to self-care in heart failure patients.

    Science.gov (United States)

    Herber, Oliver Rudolf; Bücker, Bettina; Metzendorf, Maria-Inti; Barroso, Julie

    2017-12-01

    Individual qualitative studies provide varied reasons for why heart failure patients do not engage in self-care, yet articles that aggregated primary studies on the subject have methodological weaknesses that justified the execution of a qualitative meta-summary. The aim of this study is to integrate the findings of qualitative studies pertaining to barriers and facilitators to self-care using meta-summary techniques. Qualitative meta-summary techniques by Sandelowski and Barroso were used to combine the findings of qualitative studies. Meta-summary techniques include: (1) extraction of relevant statements of findings from each report; (2) reduction of these statements into abstracted findings and (3) calculation of effect sizes. Databases were searched systematically for qualitative studies published between January 2010 and July 2015. Out of 2264 papers identified, 31 reports based on the accounts of 814 patients were included in the meta-summary. A total of 37 statements of findings provided a comprehensive inventory of findings across all reports. Out of these statements of findings, 21 were classified as barriers, 13 as facilitators and three were classed as both barriers and facilitators. The main themes relating to barriers and facilitators to self-care were: beliefs, benefits of self-care, comorbidities, financial constraints, symptom recognition, ethnic background, inconsistent self-care, insufficient information, positive and negative emotions, organizational context, past experiences, physical environment, self-initiative, self-care adverse effects, social context and personal preferences. Based on the meta-findings identified in this study, future intervention development could address these barriers and facilitators in order to further enhance self-care abilities in heart failure patients.

  16. Tsunami Risk for the Caribbean Coast

    Science.gov (United States)

    Kozelkov, A. S.; Kurkin, A. A.; Pelinovsky, E. N.; Zahibo, N.

    2004-12-01

    The tsunami problem for the coast of the Caribbean basin is discussed. Briefly the historical data of tsunami in the Caribbean Sea are presented. Numerical simulation of potential tsunamis in the Caribbean Sea is performed in the framework of the nonlinear-shallow theory. The tsunami wave height distribution along the Caribbean Coast is computed. These results are used to estimate the far-field tsunami potential of various coastal locations in the Caribbean Sea. In fact, five zones with tsunami low risk are selected basing on prognostic computations, they are: the bay "Golfo de Batabano" and the coast of province "Ciego de Avila" in Cuba, the Nicaraguan Coast (between Bluefields and Puerto Cabezas), the border between Mexico and Belize, the bay "Golfo de Venezuela" in Venezuela. The analysis of historical data confirms that there was no tsunami in the selected zones. Also, the wave attenuation in the Caribbean Sea is investigated; in fact, wave amplitude decreases in an order if the tsunami source is located on the distance up to 1000 km from the coastal location. Both factors wave attenuation and wave height distribution should be taken into account in the planned warning system for the Caribbean Sea.

  17. Caribbean contributions to contemporary psychiatric psychopathology.

    Science.gov (United States)

    Hickling, F W; Hutchinson, G

    2012-07-01

    The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.

  18. Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial.

    Science.gov (United States)

    Raftery, James P; Yao, Guiqing L; Murchie, Peter; Campbell, Neil C; Ritchie, Lewis D

    2005-03-26

    To establish the cost effectiveness of nurse led secondary prevention clinics for coronary heart disease based on four years' follow up of a randomised controlled trial. Cost effectiveness analysis. 19 general practices in north east Scotland. 1343 patients (673 in intervention group and 670 in control group, as originally randomised) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound. Nurse led clinics to promote medical and lifestyle components of secondary prevention. Costs of clinics; overall costs to health service; and cost per life year and per quality adjusted life year (QALY) gained, expressed as incremental gain in intervention group compared with control group. The cost of the intervention (clinics and drugs) was 136 pounds sterling (254 dollars; 195 euros) per patient higher (1998-9 prices) in the intervention group, but the difference in other NHS costs, although lower for the intervention group, was not statistically significant. Overall, 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs. The incremental cost per life year saved was 1236 pounds sterling and that per QALY was 1097 pounds sterling. Nurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care, with the main gains in life years saved.

  19. Artists in and out of the Caribbean

    Directory of Open Access Journals (Sweden)

    Sally Price

    1999-07-01

    Full Text Available [First paragraph] Caribbean Art. VEERLE POUPEYE. London: Thames and Hudson, 1998. 224 pp. (Paper US$ 14.95 Transforming the Crown: African, Asian and Caribbean Artists in Britain, 1966-1996. MORA J. BEAUCHAMP-BYRD & M. FRANKLIN SIRMANS (eds.. New York: Caribbean Cultural Center, 1998. 177 pp. (Paper US$ 39.95, £31.95 "Caribbean" (like "Black British" culture is (as a Dutch colleague once said of postmodernism a bit of a slippery fish. One of the books under review here presents the eclectic artistic productions of professional artists with Caribbean identities of varying sorts - some of them lifelong residents of the region (defined broadly to stretch from Belize and the Bahamas to Curacao and Cayenne, some born in the Caribbean but living elsewhere, and others from far-away parts of the world who have lingered or settled in the Caribbean. The other focuses on artists who trace their cultural heritage variously to Lebanon, France, Malaysia, Spain, China, England, Guyana, India, the Caribbean, the Netherlands, the Philippines, and the whole range of societies in West, East, and Central Africa, all of whom meet under a single ethnic label in galleries in New York and London. Clearly, the principles that vertebrate Caribbean Art and Transforming the Crown are built on the backs of ambiguities, misperceptions, ironies, and ethnocentric logics (not to mention their stronger variants, such as racism. Yet far from invalidating the enterprise, they offer an enlightening inroad to the social, cultural, economic, and political workings of artworlds that reflect globally orchestrated pasts of enormous complexity.

  20. Determinants and promotion of oral hygiene behaviour in the Caribbean and Nepal

    NARCIS (Netherlands)

    Buunk-Werkhoven, Yvonne A. B.; Dijkstra, Arie; Bink, Pim; van Zanten, Sarah; van der Schans, Cees P.; van, Zanten S.

    2011-01-01

    The purpose of this study was to identify predictors of oral hygiene behaviour (OHB) based on the Theory of Planned Behaviour (TPB) among dental care seekers in two cultural different regions: the Caribbean (Aruba/Bonaire) and Nepal. In addition, measures of oral health knowledge (OHK) and the

  1. The Effect of Self-Care Education on the Awareness, Attitude, and Adherence to Self-Care Behaviors in Hospitalized Patients Due to Heart Failure with and without Depression.

    Directory of Open Access Journals (Sweden)

    Ali Navidian

    Full Text Available Cardiovascular diseases are among somatic disorders and psychological factors affect their onset, exacerbation, and treatment. This study was conducted on the hospitalized patients who had heart failure with and without depression. The study criteria was to evaluate the effect of self-care education on awareness, attitude, and adherence to self-care behaviors on these patients.In this quasi-experimental study, seventy patients with heart failure that met the inclusion criteria were recruited through purposive sampling method. They were assigned in to two equal size groups regarding their depression status. First, the eligible patients were selected; then Beck Depression Inventory was done on the patients followed by examination by the clinical psychologist. Patients with average and higher scores were classified in the depressed group and others who got lower than average scores were classified as the non -depressed group. A questionnaire containing items related to awareness, attitude, and adherence to self-care behaviors was used to collect the data. First, self-care behavior was determined and then a four-sessions of educational intervention were held individually for both groups. The second round of questionnaires were completed at patients' home twelve weeks after the discharge. The Collected data was analyzed using independent-samples and paired-sample t tests, Chi square, and statistical analysis of covariance (ANCOVA tests through SPSS (version 21, SPSS Inc., Chicago, IL, USA.After the educational sessions, the statistical analysis showed significant differences in the mean scores of awareness, attitude, and adherence to self-care behaviors between the two groups (P<0.0001.Self-care behavior education had lower effects on the depressed patients with heart failure. Therefore, before providing education for these patients, it is necessary to consider their psychological problems such as depression.

  2. Preferences of people with advanced heart failure-a structured narrative literature review to inform decision making in the palliative care setting.

    Science.gov (United States)

    Dev, Sandesh; Abernethy, Amy P; Rogers, Joseph G; O'Connor, Christopher M

    2012-09-01

    BACKGROUND AND APPROACH: There is a growing emphasis on the need for high-quality and patient-centered palliative care for patients with heart failure (HF) near end of life. Accordingly, clinicians require adequate knowledge of patient values and preferences, but this topic has been underreported in the HF literature. In response, we conducted a structured narrative review of available evidence regarding patient preferences for HF care near end of life, focusing on circumstances of death, advance care planning, and preferences for specific HF therapies. Patients had widely varying preferences for sudden ("unaware") death versus a death that was anticipated ("aware"), which would allow time to make arrangements and time with family; preferences influenced their choice of HF therapies. Patients and physicians rarely discussed advance care planning; physicians were rarely aware of resuscitation preferences. Advance care planning discussions rarely included preferences for limiting implantable cardioverter defibrillator use, and patients were often uninformed of the option of implantable cardioverter defibrillator deactivation. A substantial minority of patients strongly preferred improved quality of life versus extended survival, but preferences of individuals could not be easily predicted. Current evidence regarding preferences of patients with HF near end of life suggests substantial opportunities for improvement of end-of-life HF care. Most notably, the wide distribution of patient preferences highlights the need to tailor approach to patient wishes, avoiding assumptions of patient wishes. A research agenda and implications for health care provider training are proposed. Copyright © 2012 Mosby, Inc. All rights reserved.

  3. Mental health advocacy and African and Caribbean men: good practice principles and organizational models for delivery

    Science.gov (United States)

    Newbigging, Karen; McKeown, Mick; French, Beverley

    2011-01-01

    Abstract Background  Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men. Aim  To investigate good practice principles and organizational models for mental health advocacy provision for African and Caribbean men. Study design  The study consisted of: (i) A systematic literature review. Bibliographic and internet searching was undertaken from 1994 to 2006. The inclusion criteria related to mental health, advocacy provision for African and Caribbean men. (ii) Four focus groups with African and Caribbean men to explore needs for and experiences of mental health advocacy. (iii) An investigation into current advocacy provision through a survey of advocacy provision in England, Wales and Northern Ireland. (iv) Twenty‐two qualitative stakeholder interviews to investigate the operation of mental health advocacy for this client group. The study was undertaken in partnership with two service user‐led organizations and an African Caribbean mental health service. Results  Primary research in this area is scant. Mainstream mental health advocacy services are often poor at providing appropriate services. Services developed by the Black Community and voluntary sector are grounded in different conceptualizations of advocacy and sharper understanding of the needs of African and Caribbean men. The lack of sustainable funding for these organizations is a major barrier to the development of high‐quality advocacy for this group, reflecting a lack of understanding about their distinctive role. Conclusions  The commissioning and provision of mental health advocacy needs to recognize the distinct experiences of African and Caribbean men and develop capacity in the range of organizations to ensure equitable access. PMID:21645185

  4. Mental health advocacy and African and Caribbean men: good practice principles and organizational models for delivery.

    Science.gov (United States)

    Newbigging, Karen; McKeown, Mick; French, Beverley

    2013-03-01

    Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men. To investigate good practice principles and organizational models for mental health advocacy provision for African and Caribbean men. The study consisted of: (i) A systematic literature review. Bibliographic and internet searching was undertaken from 1994 to 2006. The inclusion criteria related to mental health, advocacy provision for African and Caribbean men. (ii) Four focus groups with African and Caribbean men to explore needs for and experiences of mental health advocacy. (iii) An investigation into current advocacy provision through a survey of advocacy provision in England, Wales and Northern Ireland. (iv) Twenty-two qualitative stakeholder interviews to investigate the operation of mental health advocacy for this client group. The study was undertaken in partnership with two service user-led organizations and an African Caribbean mental health service. Primary research in this area is scant. Mainstream mental health advocacy services are often poor at providing appropriate services. Services developed by the Black Community and voluntary sector are grounded in different conceptualizations of advocacy and sharper understanding of the needs of African and Caribbean men. The lack of sustainable funding for these organizations is a major barrier to the development of high-quality advocacy for this group, reflecting a lack of understanding about their distinctive role. The commissioning and provision of mental health advocacy needs to recognize the distinct experiences of African and Caribbean men and develop capacity in the range of organizations to ensure equitable access. © 2011 Blackwell Publishing Ltd.

  5. Development of a Web-Based Health Care Intervention for Patients With Heart Disease: Lessons Learned From a Participatory Design Study.

    Science.gov (United States)

    Noergaard, Birgitte; Sandvei, Marianne; Rottmann, Nina; Johannessen, Helle; Wiil, Uffe; Schmidt, Thomas; Pedersen, Susanne S

    2017-05-17

    The use of telemedicine technologies in health care has increased substantially, together with a growing interest in participatory design methods when developing telemedicine approaches. We present lessons learned from a case study involving patients with heart disease and health care professionals in the development of a personalized Web-based health care intervention. We used a participatory design approach inspired by the method for feasibility studies in software development. We collected qualitative data using multiple methods in 3 workshops and analyzed the data using thematic analysis. Participants were 7 patients with diagnosis of heart disease, 2 nurses, 1 physician, 2 systems architects, 3 moderators, and 3 observers. We present findings in 2 parts. (1) Outcomes of the participatory design process: users gave valuable feedback on ease of use of the platforms' tracking tools, platform design, terminology, and insights into patients' monitoring needs, information and communication technologies skills, and preferences for self-management tools. (2) Experiences from the participatory design process: patients and health care professionals contributed different perspectives, with the patients using an experience-based approach and the health care professionals using a more attitude-based approach. The essential lessons learned concern planning and organization of workshops, including the finding that patients engaged actively and willingly in a participatory design process, whereas it was more challenging to include and engage health care professionals. ©Birgitte Noergaard, Marianne Sandvei, Nina Rottmann, Helle Johannessen, Uffe Wiil, Thomas Schmidt, Susanne S Pedersen. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 17.05.2017.

  6. The cultural politics of biomedicine in the Caribbean

    Directory of Open Access Journals (Sweden)

    Paul E. Brodwin

    1998-01-01

    Full Text Available [First paragraph] Healing the Masses: Cuban Health Politics at Home and Abroad. JULIE M. FEINSILVER. Berkeley: University of California Press, 1993. xx + 307 pp. (Cloth US$ 45.00, Paper US$ 17.00 The Blessings of Motherhood: Health, Pregnancy and Child Care in Dominica. ANJA KRUMEICH. Amsterdam: Het Spinhuis, 1994. iii + 278 pp. (Paper NLG 47.50 Disability and Rehabilitation in Rural Jamaica: An Ethnographic Study. RONNIE LINDA LEAVITT. Rutherford NJ: Fairleigh Dickinson University Press; London: Associated University Presses, 1992. 249 pp. (Cloth US$ 39.50 Based on research in three Caribbean societies, these books explore the contours of biomedicine ("Western" or scientific medicine as a cultural system and an instrument of state power. On a theoretical level, the authors take up the blurred boundaries between Western biomedicine and other forms of healing as well as the political meanings and contradictions hidden behind everyday clinical routines. Their particular research projects, however, ask what has happened to the dream of universally accessible medical care in the past twenty years in the Caribbean region. The books focus on a community-based pediatric disability program in Jamaica(Leavitt, maternal and child health care in Dominica (Krumeich, and Cuba's national project of medical modernization (Feinsilver. Specific diseases or clinical outcomes are less at issue than the cultural and political dimensions of planned health development and the social transformations it sets into motion on both local and national levels.

  7. Co-morbid Non-communicable Diseases and Associated Health Service Use in African and Caribbean Immigrants with HIV.

    Science.gov (United States)

    Masindi, Khatundi-Irene; Jembere, Nathaniel; Kendall, Claire E; Burchell, Ann N; Bayoumi, Ahmed M; Loutfy, Mona; Raboud, Janet; Rourke, Sean B; Luyombya, Henry; Antoniou, Tony

    2017-12-05

    We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario's linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population.

  8. Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients.

    Science.gov (United States)

    Comín-Colet, Josep; Verdú-Rotellar, José María; Vela, Emili; Clèries, Montse; Bustins, Montserrat; Mendoza, Lola; Badosa, Neus; Cladellas, Mercè; Ferré, Sofía; Bruguera, Jordi

    2014-04-01

    The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309,345. For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service). We included 56,742 patients in the study. There were 181,204 hospital admissions and 30,712 deaths during the study period. In the adjusted analyses, when compared to the 54,659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established. The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  9. How doctors' communication style and race concordance influence African-Caribbean patients when disclosing depression.

    Science.gov (United States)

    Adams, A; Realpe, A; Vail, L; Buckingham, C D; Erby, L H; Roter, D

    2015-10-01

    To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression. 160 African-Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2×2×2 factorial design. Afterwards, participants rated aspects of doctors' communication style, their comfort in disclosing depression and treatment preferences Race concordance had no impact on African-Caribbeans' comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p=0.000), their overall comfort (p=0.003), their comfort in disclosing their emotional state (p=0.001), and about considering talking therapy (p=0.01); but less positive about considering antidepressant medication (p=0.01). Doctors' communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans' depression consultation experiences. Changing doctors' communication style may help reduce disparities in depression care. Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  10. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences

    OpenAIRE

    Moeini, Mahin; Khadibi, Maryam; Bekhradi, Reza; Mahmoudian, Seyed Ahmad; Nazari, Fatemeh

    2010-01-01

    BACKGROUND: Sleep disorder is one of the common problems patients face in ICU and CCU and it is usually treated by sleeping pills. Nowadays, the complementary medicine is highly considered because of its effectiveness and safety. Aromatherapy is one of the holistic nursing cares which sees human beings as a biological, mental and social unit while the psychological dimension has the central role. Each of these dimensions is dependent on each other and is affected by each other. Therefore, it ...

  11. Change of heart. How a team of North Kirklees primary care trust clinicians used performance management principles to improve coronary heart disease services.

    Science.gov (United States)

    Jackson, Sue; Morgan, Gillian

    2007-01-01

    North Kirklees, an urban area in the East of England, known to have a 6.8 percent incidence of Coronary Heart Disease (CHD), embarked on a nurse-led CHD primary prevention service in order to improve residents' health. This paper seeks to investigate this serice. Keen to utilise the principles of performance management, the team applied the European Foundation for Quality Management (EFQM) Excellence Model RADAR logic believing that it would strengthen their "results orientation". This paper investigates the results. Using RADAR, the team identified baseline data for CHD health indicators. The teams were then equipped to set targets for continuous improvement, thereby increasing their potential to progress local residents' health. The case-study findings enable others to adopt a similar approach in their pursuit of excellence. The CHD Primary Prevention team focused only on performance results in the first instance and did not look at other EFQM Excellence Model results areas. The paper describes an original case study into how nurses applied RADAR, which gives insight into the team's experiences during their 18-month journey.

  12. Caribbean | IDRC - International Development Research Centre

    International Development Research Centre (IDRC) Digital Library (Canada)

    speaking Caribbean. Our work has helped reduce poverty and inequality, restore degraded coastal systems, and protect communities against disease and natural disasters. Our research has also helped improve farming and fishing practices, and ...

  13. Caribbean Marine Mammal Assessment Vessel Surveys

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data sets are a compilation of large vessel surveys for marine mammal stock assessments in Caribbean waters conducted during 2000-2001. These surveys were...

  14. Ischaemic heart disease

    DEFF Research Database (Denmark)

    Houlberg Hansen, Louise; Mikkelsen, Søren

    2013-01-01

    Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD) may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU) in Odense, Denmark...

  15. The use of patient-reported outcomes becomes standard practice in the routine clinical care of lung–heart transplant patients

    Directory of Open Access Journals (Sweden)

    Maria J Santana

    2010-09-01

    Full Text Available Maria J Santana1, David Feeny2, Justin Weinkauf1, Roland Nador1, Ali Kapasi1, Kathleen Jackson1, Marianne Schafenacker1, Dalyce Zuk1, Dale Lien11Lung Transplant Program, University of Alberta Hospital, Edmonton, Alberta, Canada; 2The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USAObjective: To assess the use of patient-reported outcome (PROs measures in the routine clinical care of lung–heart transplant patients. We assessed whether the addition of PROs in routine clinical care affected the duration of the consultation and patient’s and clinician’s views.Method: Consecutive lung–heart transplant patients visiting the outpatient clinic, University of Alberta Hospital, completed the Chronic Respiratory Questionnaire (CRQ and the Health Utilities Index (HUI on touchscreen computers. Information on the patient’s responses was made available to the members of the transplant team prior to the encounter with the patient. The duration of clinical encounters was noted. At the end of every visit, clinicians completed a questionnaire on the usefulness of having PRO information available. After 6 months patients completed a survey of their experiences.Results: The final patient sample consisted of 172 patients with a mean (SD age of 52 (13.3 years old; 47% were female; 68% were organ recipients and 32% candidates. The transplant team, comprising four pulmunologists, two nurses, and one pharmacist had an average of 9 years of practical experience in pulmunology. The mean duration of patient–clinician encounters in minutes was 15.15 (4.52. Ninety-eight percent of patients indicated that they would be happy to complete the CRQ and HUI at every clinic visit. Ninety-one percent of the assessments completed by clinicians showed complete satisfaction with the use of PROs in routine practice. Further, the clinicians developed guidelines for the use of PRO information in clinical practice.Conclusions: The incorporation of PRO

  16. The Tectonic Evolution of Caribbean Ophiolites

    Science.gov (United States)

    Draper, G.

    2001-12-01

    Ophiolitic rocks (associated basalts, gabbros and ultramafic rocks) occur in many areas in the circum-Caribbean and Central America. These ophiolites are derived principally from two oceanic provinces: (1) the Atlantic realm, proto-Caribbean sea that formed when North America separated from South America during the opening of the North Atlantic during Jurassic and Early Cretaceous time. These ophiolites were emplaced during a series of late Cretaceous to early Tertiary arc-continent collisions as the east facing Antilles arc migrated into the Caribbean realm. These occurrences include Guatamala, northern Cuba, northern Hispaniola, and northern Venezuela. (2) the Pacific realm, late Cretaceous Caribbean-Colombian plateau that now occupies the central Caribbean, but outcrops on land in Costa Rica, SW Hispaniola, the Netherlands Antilles and western Colombia. Accretion, emplacement and uplift was aided by their buoyancy and took place at various times during the Caribbean plateau's insertion into the middle American continental gap. A third set of occurrences are more uncertain in origin. The central Hispaniola and SE Puerto Rico ophiolites seem to be Jurassic age oceanic plateau rocks that were emplaced in mid-Cretaceous time during an, subduction polarity reversal episode. The emplacement of the metamorphosed ophiolitic rocks of eastern Jamaica may also be associated with this event, but the adjacent, upper Cretaceous, Bath-Dunrobin complex seems to be more related to the Campanian Yucatan-Antillean arc collision. The ultramafic rocks of Tobago are not oceanic, but represent Alaksan-type, assemblages.

  17. Heart and vascular services

    Science.gov (United States)

    ... maintain body temperature, among other things. CARDIOVASCULAR MEDICINE Cardiovascular medicine refers to the branch of health care that specializes in the treatment of diseases or conditions dealing with the heart and vascular systems. Common ...

  18. American Heart Association

    Science.gov (United States)

    ... Americans live with heart disease, stroke or a cardiovascular condition. Your donation will help us save and improve their lives with research, education and emergency care. Warning Signs If you or someone else is ...

  19. Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care

    Directory of Open Access Journals (Sweden)

    Nazareth Irwin

    2006-04-01

    Full Text Available Abstract Background People with severe mental illness (SMI are at increased risk of developing coronary heart disease (CHD and there is growing emphasis on the need to monitor their physical health. However, there is little consensus on how services for the primary prevention of CHD should be organised for this patient group. We explored the views of people with SMI and health professionals from primary care and community mental health teams (CMHTs on how best to provide these services. Methods In-depth interviews were conducted with a purposive sample of patients with SMI (n = 31 and staff from primary care (n = 10 and community mental health teams (n = 25 in North Central London. Transcripts of the qualitative interviews were analysed using a 'framework' approach to identify the main themes in opinions regarding various service models. Results Cardiovascular risk factors in people with SMI were of concern to participants. However, there was some disagreement about the best way to deliver appropriate care. Although staff felt that primary care should take responsibility for risk factor screening and management, patients favoured CHD screening in their CMHT. Problems with both approaches were identified. These included a lack of familiarity in general practice with SMI and antipsychotic side effects and poor communication of physical health issues to the CMHT. Lack of knowledge regarding CHD risk factor screening and difficulties in interpreting screening results and implementing appropriate interventions exist in secondary care. Conclusion Management of physical health care for people with SMI requires complex solutions that cross the primary-secondary care interface. The views expressed by our participants suggest that neither primary nor secondary care services on their own can provide a comprehensive service for all patients. The increased risk of CHD associated with SMI and antipsychotic medications requires flexible solutions with clear

  20. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia care,...

  1. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  2. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia care,...

  3. Burden of caring: risks and consequences imposed on caregivers of those living and dying with advanced heart failure

    NARCIS (Netherlands)

    A. Strömberg; M.L. Luttik

    2015-01-01

    PURPOSE OF REVIEW: To summarize the latest research on the risks and consequences of the burden that may be imposed on informal carers of persons living and dying with advanced heart failure. RECENT FINDINGS: A systematic search in PubMed over the period 2013-2014 ultimately revealed 24 original

  4. Health Gain through Screening--Coronary Heart Disease and Stroke: Developing Primary Health Care Services for People with Intellectual Disability.

    Science.gov (United States)

    Wells, M. B.; Turner, S.; Martin, D. M.; Roy, A.

    1997-01-01

    A study of 120 British adults with intellectual disability found they had higher risk factors of developing coronary heart disease and stroke than the general population. There was a greater incidence of obesity and considerably lower physical activity levels than the general population. Several also had abnormal cholesterol readings. (CR)

  5. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial) - design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, A.D.O.; Schou, O.; Soja, A.M.B.

    2005-01-01

    Background Current guidelines broadly recommend comprehensive cardiac rehabilitation (CR), although evidence for this is still limited. It is not known whether evidence from before 1995 is still valid. Study Design The DANish Cardiac REHABilitation (DANREHAB) trial was designed as a centrally......, or readmissions due to heart disease based on linkage to public registries. The CR was an individually tailored, multidisciplinary program (6 weeks of intensive CR and 12 months of follow-up) including patient education, exercise training, dietary counseling, smoking cessation, psychosocial support, risk factor...

  6. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Brønnum-Hansen, Henrik

    2005-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CR), although evidence for this is still limited. It is not known whether evidence from before 1995 is still valid. STUDY DESIGN: The DANish Cardiac ReHABilitation (DANREHAB) trial was designed as a centrally......, or readmissions due to heart disease based on linkage to public registries. The CR was an individually tailored, multidisciplinary program (6 weeks of intensive CR and 12 months of follow-up) including patient education, exercise training, dietary counseling, smoking cessation, psychosocial support, risk factor...

  7. Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

    Directory of Open Access Journals (Sweden)

    Cucalón José M

    2006-02-01

    Full Text Available Abstract Background Ischaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors using the information gathered by primary care practitioners on cardiovascular health of their population. Methods A prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses. Results Mean age at recruitment was 51.6 ± 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate

  8. The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument.

    Science.gov (United States)

    Jaarsma, Tiny; Arestedt, Kristofer Franzén; Mårtensson, Jan; Dracup, Kathleen; Strömberg, Anna

    2009-01-01

    Improved self-care is the goal of many heart failure (HF) management programmes. The 12-item European Heart Failure Self-Care Behaviour Scale (EHFScB scale) was developed and tested to measure patient self-care behaviours. It is now available in 14 languages. The aim of this study was to further determine reliability and validity of the EHFScB scale. Data from 2592 HF patients (mean age 73 years, 63% male) from six countries were analysed. Internal consistency was determined by Cronbach's alpha. Validity was established by (1) interviews with HF experts and with HF patients; (2) item analysis; (3) confirmatory factor analysis; and (4) analysing the relationship between the EHFScB scale and scales measuring quality of life and adherence. Internal consistency of the 12-item scale was 0.77 (0.71-0.85). After factor analyses and critical evaluation of both psychometric properties and content of separate items, a nine-item version was further evaluated. The reliability estimates for the total nine-item scale (EHFScB-9) was satisfactory (0.80) and Cronbach's alpha varied between 0.68 and 0.87 in the different countries. One reliable subscale was defined (consulting behaviour) with a Cronbach's alpha of 0.85. The EHFScB-9 measures a different construct than quality of life (r = 0.18) and adherence (r = 0.37). The 12-item EHFScB scale was revised into the nine-item EHFScB-9, which can be used as an internally consistent and valid instrument to measure HF-related self-care behaviour.

  9. Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: a qualitative interview study.

    Science.gov (United States)

    Carlsson, Tommy; Marttala, Ulla Melander; Mattsson, Elisabet; Ringnér, Anders

    2016-06-02

    Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants. Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis. The analysis resulted in five categories: 1) "Trustworthy information", 2) "Language barriers", 3) "Psychosocial situation", 4) "Peer support", and 5) "Religious positions". The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

  10. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences.

    Science.gov (United States)

    Moeini, Mahin; Khadibi, Maryam; Bekhradi, Reza; Mahmoudian, Seyed Ahmad; Nazari, Fatemeh

    2010-01-01

    Sleep disorder is one of the common problems patients face in ICU and CCU and it is usually treated by sleeping pills. Nowadays, the complementary medicine is highly considered because of its effectiveness and safety. Aromatherapy is one of the holistic nursing cares which sees human beings as a biological, mental and social unit while the psychological dimension has the central role. Each of these dimensions is dependent on each other and is affected by each other. Therefore, it is fundamental for nurses to provide aromatherapy in their clinical performance. Aromatherapy helps treatment of diseases by using vegetable oils and it seems to be effective in reducing sleeplessness. This was a clinical trial on 64 patients (male and female) hospitalized in CCU in Al-zahra and Chamran hospitals. The intervention included 3 nights, each time 9 hours aromatherapy with lavender oil for the experiment group, while the controls received no intervention. Both groups filled out the SMHSQ that includes 11 items to assess sleep quality before and after intervention. Data analysis showed that the mean scores of sleep quality in the two groups of experiment and control were significantly different after the aromatherapy with lavender oil (p aromatherapy with lavender oil. Therefore, using aromatherapy can improve the quality of their sleep and health.

  11. Heart Failure

    Science.gov (United States)

    Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped ... and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and ...

  12. SEAMAP Caribbean Reef Fish Survey (PC1202, EK60)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Objectives of the 2012 SEAMAP Caribbean Reef Fish Survey were to assess relative abundance of reef fish species around the US Caribbean Islands, estimate...

  13. SEAMAP Caribbean Reef Fish Survey (PC1202, ME70)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Objectives of the 2012 SEAMAP Caribbean Reef Fish Survey were to assess relative abundance of reef fish species around the US Caribbean Islands, estimate...

  14. 78 FR 14078 - Caribbean Fishery Management Council; Public Meeting

    Science.gov (United States)

    2013-03-04

    ... National Oceanic and Atmospheric Administration RIN 0648-XC531 Caribbean Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice of public meeting. SUMMARY: The Caribbean Fishery Management Council's...

  15. 78 FR 32623 - Caribbean Fishery Management Council; Public Meetings

    Science.gov (United States)

    2013-05-31

    ... National Oceanic and Atmospheric Administration RIN 0648-XC706 Caribbean Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice of public meetings. SUMMARY: The Caribbean Fishery Management Council's...

  16. 76 FR 10562 - Caribbean Fishery Management Council; Public Meeting

    Science.gov (United States)

    2011-02-25

    ... Caribbean Fishery Management Council's (Council) Scientific and Statistical Committee (SSC) will hold a... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National.... FOR FURTHER INFORMATION CONTACT: Caribbean Fishery Management Council, 268 Mu[ntilde]oz Rivera Avenue...

  17. 75 FR 6178 - Caribbean Fishery Management Council; Public Meeting

    Science.gov (United States)

    2010-02-08

    ... Caribbean Fishery Management Council's (CFMC) Scientific and Statistical Committee (SSC) will hold a meeting... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... FOR FURTHER INFORMATION CONTACT: Caribbean Fishery Management Council, 268 Munoz Rivera Avenue, Suite...

  18. 77 FR 7136 - Caribbean Fishery Management Council; Public Meetings

    Science.gov (United States)

    2012-02-10

    ... Caribbean Fishery Management Council's Scientific and Statistical Committee (SSC) and the Advisory Panel (AP... Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National... St., Carolina, Puerto Rico. FOR FURTHER INFORMATION CONTACT: Caribbean Fishery Management Council...

  19. 78 FR 64200 - Caribbean Fishery Management Council; Public Meetings

    Science.gov (United States)

    2013-10-28

    ... Caribbean Fishery Management Council's (Council) Scientific and Statistical Committee (SSC) will hold... Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National... held at the Caribbean Fishery Management Council Headquarters, located at 270 Mu[ntilde]oz Rivera...

  20. Telemedicine Based Ultrasound for Detecting Neonatal Heart Disease in Babies at Remote Military of Native American Health Care Facilities

    National Research Council Canada - National Science Library

    Sahn, David J

    2006-01-01

    ... & Science University in Portland, will test the hypothesis that trained primary care practitioners or nurses can, with telemedicine supervision, perform cardiac ultrasound exams on neonates at risk...

  1. Telemedicine Based Ultrasound for Detecting Neonatal Heart Disease in Babies at Remote Military or Native American Health Care Facilities

    National Research Council Canada - National Science Library

    Sahn, David J; Kinney, James; Puntel, Robert

    2007-01-01

    ... & Science University in Portland will test the hypothesis that trained primary care practitioners or nurses can with telemedicine supervision perform cardiac ultrasound exams on neonates at risk...

  2. Telemedicine Based Ultrasound for Detecting Neonatal Heart Disease in Babies at Remote Military or Native American Health Care Facilities

    National Research Council Canada - National Science Library

    Sahn, David J; Kinney, James; Puntel, Robert

    2008-01-01

    ... & Science University in Portland will test the hypothesis that trained primary care practitioners or nurses can with telemedicine supervision perform cardiac ultrasound exams on neonates at risk...

  3. The effect of guided reflection on heart failure self-care maintenance and management: A mixed methods study.

    Science.gov (United States)

    Sethares, Kristen A; Asselin, Marilyn E

    Evaluate the effect of structured, guided reflection on patient descriptions of self-care maintenance and management. Inadequate HF self-care behaviors are linked to hospitalizations. Symptom monitoring and recognition are precursors to adequate HF self-care. Reflection on actions taken during HF exacerbations may lead to insights and future changes in HF self-care maintenance and management. One-group mixed method pre-test/post-test design. Following cognitive screening, self-care maintenance and management was measured prior to the intervention at a home visit one-week after hospital discharge, and one-month post intervention. Qualitative data consisted of audiotaped individual interviews with participants, field notes and reflective diaries kept by patients. The results (N = 10) demonstrate large effect sizes and increases in self-care maintenance (69.9 vs 79.6, d = 1.04) and management (47.2 vs 63.9, d = 2.53) scores after intervention. Eight themes emerged from the data that reflected the HF participant's experience of self-care. Reflection evoked emotions around concerns for family and mortality. Participants linked symptoms experienced with contextual factors which facilitated discussion about changing future actions. Purposeful reflection may be necessary for the development of self-care. Guided reflection on previous actions that includes contextual considerations may also play a role in enhancing self-care management by allowing the person to more fully understand the illness experience. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. ECHOCARDIOGRAPHIC PROFILE OF VALVULAR LESIONS IN CHILDREN WITH ACUTE RHEUMATIC FEVER / RHEUMATIC HEART DISEASE IN A TERTIARY CARE HOSPITAL

    OpenAIRE

    Ramu; Deepak Kumar

    2015-01-01

    CONTEXT (B ACKGROUND): Rheumatic Heart disease is still a leading cause of valvular disease in developing countries like India and constitutes 10 to 50% of the cardiac patients in Indian hospitals. Echocardiography is a very sensitive investigation for the diagnosis of Rheumatic Carditis and its sequalae like Mitral, Aortic and Tricuspid valve disease as well as sub clinical Carditis. AIMS & OBJECTIVES: To study the profile, severity and gender based differences of ...

  5. Reducing Readmissions among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up.

    Science.gov (United States)

    Murtaugh, Christopher M; Deb, Partha; Zhu, Carolyn; Peng, Timothy R; Barrón, Yolanda; Shah, Shivani; Moore, Stanley M; Bowles, Kathryn H; Kalman, Jill; Feldman, Penny H; Siu, Albert L

    2017-08-01

    To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care. National Medicare administrative, claims, and patient assessment data. Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality. An extension of instrumental variables methods for nonlinear statistical models corrects for nonrandom selection of patients into treatment categories. Our instruments are the index hospital's rate of early aftercare for non-HF patients and hospital discharge day of the week. All hospitalizations for a HF principal diagnosis with discharge to home health care between July 2009 and June 2010 were identified from source files. Neither treatment by itself has a statistically significant effect on hospital readmission. In combination, however, they reduce the probability of readmission by roughly 8 percentage points (p home health and medical providers in the clinical management of HF patients immediately after hospital discharge. © Health Research and Educational Trust.

  6. Heart Anatomy

    Science.gov (United States)

    ... kilometers), which is far enough to circle the earth more than twice! See also on other sites: ... For the Public Heart Information Center Project Heart Women’s Heart Health Clinical Trials 6770 Bertner Avenue Houston, ...

  7. Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure—A grounded theory study

    Science.gov (United States)

    Östman, Malin; Ung, Eva Jakobsson; Falk, Kristin

    2015-01-01

    Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: “Experiencing a subordinate approach,” “Objectifying during the encounter” and “Expected to be compliant.” This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: “Experiencing an empowering approach,” “Person-centredness during the encounter” and “Expected to be capable.” It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals’ attitudes and communication in encounters with patients. Health care must be designed to support and promote patients’ own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a

  8. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren

    2008-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic ...

  9. Task delegation and computerized decision support reduce coronary heart disease risk factors in type 2 diabetes patients in primary care.

    Science.gov (United States)

    Cleveringa, Frits G W; Gorter, Kees J; van den Donk, Maureen; Pijman, Peter L W; Rutten, Guy E H M

    2007-10-01

    Reducing cardiovascular risk in patients with diabetes mellitus type 2 (DM2) is important in diabetes care. However, treating patients according to clinical guidelines appears to be difficult. Delegating routine tasks to a practice nurse combined with computerized decision support systems (CDSS) may be helpful. The objective was to study the effectiveness of practice nurse-managed CDSS for diabetes care on improving cardiovascular risk factors in DM2 patients. In 113 primary care practices (n = 7,893 DM2 patients) across the Netherlands, the diabetes care protocol (DCP) was assessed in a before-after study, lasting 1 year. All practices implemented DCP, which is characterized by delegation of routine tasks in diabetes care to a practice nurse, software that supports diabetes management, medical decisions, and benchmarking (CDSS). All DM2 patients treated by their primary care physician were asked to attend the program. Primary outcome was the percentage of patients achieving treatment targets: hemoglobin A1c (HbA1c) Delegating routine tasks in diabetes care to a practice nurse combined with CDSS and benchmarking helps achieve treatment goals for HbA1c, blood pressure, and cholesterol and reduce cardiovascular risk of DM2 patients in primary care.

  10. Organization and staffing practices in US cardiac intensive care units: a survey on behalf of the American Heart Association Writing Group on the Evolution of Critical Care Cardiology.

    Science.gov (United States)

    O'Malley, Ryan G; Olenchock, Benjamin; Bohula-May, Erin; Barnett, Christopher; Fintel, Dan J; Granger, Christopher B; Katz, Jason N; Kontos, Michael C; Kuvin, Jeffrey T; Murphy, Sabina A; Parrillo, Joseph E; Morrow, David A

    2013-03-01

    The cardiac intensive care unit (CICU) has evolved into a complex patient-care environment with escalating acuity and increasing utilization of advanced technologies. These changing demographics of care may require greater clinical expertise among physician providers. Despite these changes, little is known about present-day staffing practices in US CICUs. We conducted a survey of 178 medical directors of ICUs caring for cardiac patients to assess unit structure and physician staffing practices. Data were obtained from 123 CICUs (69% response rate) that were mostly from academic medical centres. A majority of hospitals utilized a dedicated CICU (68%) and approximately half of those hospitals employed a 'closed' unit model. In 46% of CICUs, an intensivist consult was available, but not routinely involved in care of critically ill cardiovascular patients, while 11% did not have a board-certified intensivist available for consultation. Most CICU directors (87%) surveyed agreed that a closed ICU structure provided better care than an open ICU and 81% of respondents identified an unmet need for cardiologists with critical care training. We report contemporary structural models and staffing practices in a sample of US ICUs caring for critically ill cardiovascular patients. Although most hospitals surveyed had dedicated CICUs, a minority of CICUs employed a 'closed' CICU model and few had routine intensivist staffing. Most CICU directors agree that there is a need for cardiologists with intensivist training and expertise. These survey data reveal potential areas for continued improvement in US CICU organizational structure and physician staffing.

  11. The Intensity of Primary Care for Heart Failure Patients: A Determinant of Readmissions? The CarPaths Study: A French Region-Wide Analysis.

    Directory of Open Access Journals (Sweden)

    Claire M Duflos

    Full Text Available We aimed to classify patients with heart failure (HF by the style of primary care they receive.We used the claim data (SNIIRAM: Système National d'Information Inter-Régime de l'Assurance Maladie of patients living in a French region. We evaluated three concepts. First, baseline clinical status with age and Charlson index. Second, primary care practice style with mean delay between consultations, quantity of nursing care, and variability of diuretic dose. Third, clinical outcomes with death during follow-up, readmission for HF, and rate of unforeseen consultations. The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style. Patients were classified using a hierarchical ascending classification based on principal components. A total of 2,751 patients were included in this study and were followed for a median of 22 months. The mean age was 78 y (SD: 12; 484 (18% died, and 818 (30% were readmitted for HF. We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734 was "low need-low intensity"; group 2 (N = 1,060 was "high need-low intensity"; and group 3 (N = 957 was "high need-high intensity". Their readmission rates were 17%, 41% and 28%, respectively.This study evaluated the link between primary care, clinical status and main clinical outcomes in HF patients. In higher need patients, a low-intensity practice style was associated with poorer clinical outcomes.

  12. The effect of the UK incentive-based contract on the management of patients with coronary heart disease in primary care.

    Science.gov (United States)

    McGovern, Matt P; Boroujerdi, Massoud A; Taylor, Michael W; Williams, David J; Hannaford, Philip C; Lefevre, Karen E; Simpson, Colin R

    2008-02-01

    The new General Medical Services (nGMS) contract was introduced in April 2004 to improve care of chronic diseases such as coronary heart disease (CHD) and reduce differences in treatment between patient subgroups. To determine whether the recording of CHD-related health indicators and prescribing of medicines have increased following the introduction of the nGMS contract and whether differences in the treatment of patients of differing age, gender and deprivation have been affected. A serial cross-sectional study carried out with 310 general practices in Scotland. The subjects were patients with CHD as identified by their GP. Main outcome measures were the recording of CHD-related health indicators and prescribing of medicines at pre- and post-contract time points (covariates: gender, age, co-morbidity, deprivation and practice size). The recording of CHD-related quality indicators and prescribing increased dramatically (mean absolute increase of 17.1%) after the introduction of the nGMS contract. Post-contract, disparities between patient subgroups, continued for certain components of care. Women were less likely to be recorded than men in 9 of 11 components of care, with older patients (7 of 11 components of care) and the most deprived (4 of 11 components of care) also less likely to have a record than the youngest and least deprived, respectively. The introduction of the new contract was associated with a dramatic rise in the recording of CHD-related quality indicators. However, not all the population benefited equally for certain aspects of care.

  13. 48 CFR 25.405 - Caribbean Basin Trade Initiative.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Caribbean Basin Trade... SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Trade Agreements 25.405 Caribbean Basin Trade Initiative. Under the Caribbean Basin Trade Initiative, the United States Trade Representative has determined that, for...

  14. Caribbean Life in New York City: Sociocultural Dimensions.

    Science.gov (United States)

    Sutton, Constance R., Ed.; Chaney, Elsa M., Ed.

    This book comprises the following papers discussing Caribbean life in New York City: (1) The Context of Caribbean Migration (Elsa M. Chaney); (2) The Caribbeanization of New York City and the Emergence of a Transnational Socio-Cultural System (Constance R. Sutton); (3) New York City and Its People: An Historical Perspective Up to World War II…

  15. Regulating private security companies in the Caribbean | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Diversity in local food production combats obesity in the Caribbean. In the Caribbean region, the combination of increased imports of processed foods and limited consumption of healthy foods, such as fresh fruit and. View moreDiversity in local food production combats obesity in the Caribbean ...

  16. From the past to the globalized future for Caribbean birds

    Science.gov (United States)

    Joseph Wunderle Jr.

    2008-01-01

    Extinctions of Caribbean animals were well underway during the period of Amerindian occupation and have continued since the arrival of Columbus. Despite high extinction rates, the Caribbean still retains high levels of terrestrial biodiversity and, for some taxa, exceptionally high levels of endemism relative to other parts of the world. The fate of the Caribbean’s...

  17. [Heart failure and nursing homes].

    Science.gov (United States)

    Aissat-Bessalem, Ouarda; François Fasille, Véronique

    Heart failure is a very common condition in elderly people, particularly those living away from home, in institutional care. The main objective of a study was to find out whether patients with heart failure admitted to a nursing home benefit or not from the same ultrasound assessment as the general population. The secondary objective was to analyse the management of residents with heart failure living in institutional care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  18. [Echinoderms (Echinodermata) of the Mexican Caribbean].

    Science.gov (United States)

    Laguarda-Figueras, Alfredo; Solis-Marín, Francisco A; Durán-González, Alicia; Ahearn, Cynthia Gust; Buitrón Sánchez, Blanca Estela; Torres-Vega, Juan

    2005-12-01

    A systematic list of the echinoderms of the Mexican Caribbean based on museum specimens of the Colección Nacional de Equinodermos, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México and the National Museum of Natural History, Smithsonian Institution, Washington, D.C. is presented. This list reveals an important echinoderm biodiversity in the Mexican Caribbean, where five of the six echinoderm classes are represented. A total of 178 echinoderm species is recorded, distributed in 113 genera, 51 families and 22 orders. 30 new records for the Mexican Caribbean are presents: Crínoidea (three), Asteroidea (two), Ophiuroidea (eleven), Echinoidea (one), Holothuroidea (thirteen).

  19. Towards indigenous feminist theorizing in the Caribbean.

    Science.gov (United States)

    Mohammed, P

    1998-01-01

    This theoretical study of feminism in the Caribbean opens by presenting the contemporary image of the Caribbean and then pointing to the continuing influence of the colonial past in the creation of contemporary community and the establishment of identity. The paper continues with a focus on three aspects of identity, or difference, that have influenced the daily articulation of feminism and academic debates. The first concerns the positions taken by women in the region's political struggles. The second is an exploration of the linguistic meanings of the gender discourse within the region. Finally, the essay examines the idea of linguistic difference in light of contemporary Western feminist views of "sexual difference" versus equality. The discussion of each of these issues is grounded in historical analysis and illustrated with specific examples. The study concludes that, in this region, feminism offers a new way to investigate the past while creating challenges and opportunities in the struggle to establish a Caribbean identity.

  20. Planning cancer control in Latin America and the Caribbean.

    Science.gov (United States)

    Goss, Paul E; Lee, Brittany L; Badovinac-Crnjevic, Tanja; Strasser-Weippl, Kathrin; Chavarri-Guerra, Yanin; St Louis, Jessica; Villarreal-Garza, Cynthia; Unger-Saldaña, Karla; Ferreyra, Mayra; Debiasi, Márcio; Liedke, Pedro E R; Touya, Diego; Werutsky, Gustavo; Higgins, Michaela; Fan, Lei; Vasconcelos, Claudia; Cazap, Eduardo; Vallejos, Carlos; Mohar, Alejandro; Knaul, Felicia; Arreola, Hector; Batura, Rekha; Luciani, Silvana; Sullivan, Richard; Finkelstein, Dianne; Simon, Sergio; Barrios, Carlos; Kightlinger, Rebecca; Gelrud, Andres; Bychkovsky, Vladimir; Lopes, Gilberto; Stefani, Stephen; Blaya, Marcelo; Souza, Fabiano Hahn; Santos, Franklin Santana; Kaemmerer, Alberto; de Azambuja, Evandro; Zorilla, Andres Felipe Cardona; Murillo, Raul; Jeronimo, Jose; Tsu, Vivien; Carvalho, Andre; Gil, Carlos Ferreira; Sternberg, Cinthya; Dueñas-Gonzalez, Alfonso; Sgroi, Dennis; Cuello, Mauricio; Fresco, Rodrigo; Reis, Rui Manuel; Masera, Guiseppe; Gabús, Raúl; Ribeiro, Raul; Knust, Renata; Ismael, Gustavo; Rosenblatt, Eduardo; Roth, Berta; Villa, Luisa; Solares, Argelia Lara; Leon, Marta Ximena; Torres-Vigil, Isabel; Covarrubias-Gomez, Alfredo; Hernández, Andrés; Bertolino, Mariela; Schwartsmann, Gilberto; Santillana, Sergio; Esteva, Francisco; Fein, Luis; Mano, Max; Gomez, Henry; Hurlbert, Marc; Durstine, Alessandra; Azenha, Gustavo

    2013-04-01

    Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Caribbean literary theory: modernist and postmodern

    Directory of Open Access Journals (Sweden)

    A. James Arnold

    1995-01-01

    Full Text Available [First paragraph] The Repeating Mand: The Caribbean and the Postmodern Perspective. ANTONIO BENITEZ-ROJO. Durham NC: Duke University Press, 1992. xi + 303 pp. (Cloth US$ 49.95, Paper US$ 15.95 Myth and History in Caribbean Fiction: Alejo Carpentier, Wilson Harris, and Edouard Glissant. BARBARA J. WEBB. Amherst: University of Massachusetts Press, 1992. x + 185 pp. (Cloth US$ 25.00 Caribbean literature has been overtaken of late by the quarrels that have pitted postmodernists against modernists in Europe and North America for the past twenty years. The modernists, faced with the fragmentation of the region that hard-nosed pragmatists and empiricists could only see as hostile to the emergence of any common culture, had sought in myth and its literary derivatives the collective impulse to transcend the divisions wrought by colonial history. Fifteen years ago I wrote a book that combined in its lead title the terms Modernism and Negritude in an effort to account for the efforts by mid-century Caribbean writers to come to grips with this problem. A decade later I demonstrated that one of the principal Caribbean modernists, Aimé Césaire, late in his career adopted stylistic characteristics that we associate with the postmodern (Arnold 1990. The example of Césaire should not be taken to suggest that we are dealing with some sort of natural evolution of modernism toward the postmodern. In fact the two terms represent competing paradigms that organize concepts and data so differently as to offer quite divergent maps of the literary Caribbean.

  2. How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study

    Directory of Open Access Journals (Sweden)

    Kato NP

    2016-02-01

    Full Text Available Naoko P Kato,1–3 Koichiro Kinugawa,1 Miho Sano,4 Asuka Kogure,4 Fumika Sakuragi,5 Kihoko Kobukata,4 Hiroshi Ohtsu,6 Sanae Wakita,4 Tiny Jaarsma,2 Keiko Kazuma7 1Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 2Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden; 3JSPS Postdoctoral Fellow for Research Abroad, Tokyo, 4Department of Nursing, 5Department of Pharmacy, The University of Tokyo Hospital, 6Department of Clinical Data Management, 7Department of Adult Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan Background: Although the effectiveness of heart failure (HF disease management programs has been established in Western countries, to date there have been no such programs in Japan. These programs may have different effectiveness due to differences in health care organization and possible cultural differences with regard to self-care. Therefore, the purpose of this study was to evaluate the effectiveness of a pilot HF program in a Japanese setting.Methods: We developed an HF program focused on enhancing patient self-care before hospital discharge. Patients were randomized 1:1 to receive the new HF program or usual care. The primary outcome was self-care behavior as assessed by the European Heart Failure Self-Care Behavior Scale (EHFScBS. Secondary outcomes included HF knowledge and the 2-year rate of HF hospitalization and/or cardiac death.Results: A total of 32 patients were enrolled (mean age, 63 years; 31% female. There was no difference in the total score of the EHFScBS between the two groups. One specific behavior score regarding a low-salt diet significantly improved compared with baseline in the intervention group. HF knowledge in the intervention group tended to improve more over 6 months than in the control group (a group-by-time effect, F=2.47, P=0.098. During a 2-year

  3. [Mortality rate of acute heart attack in Zalaegerszeg micro-region. Results of the first Hungarian 24-hour acute ST-elevation myocardial infarction intervention care unit].

    Science.gov (United States)

    Lupkovics, Géza; Motyovszki, Akos; Németh, Zoltán; Takács, István; Kenéz, András; Burkali, Bernadett; Menyhárt, Ildikó

    2010-04-04

    Morbidity and mortality rates of acute heart attack emphasize the significance of this patient group worldwide. The prompt and exact diagnosis and the timing of adequate therapy is crucial for this patients. Modern supply of acute heart attack includes invasive cardiology intervention, primer percutaneous coronary intervention. In year 1999, American and European recommendations suggested primer percutaneous coronary intervention only as an alternative possibility instead of thrombolysis, or in case of cardiogenic shock. 24 hour intervention unit for patients with acute heart attack was first organized in Hungary in Zala County Hospital's Cardiology Department, in year 1998. Our present study confirms, that since the intervention treatment has been introduced, average mortality rate has been reduced considerably in our area comparing to the national average. Mortality rates in West Transdanubian region and in Zalaegerszeg's micro-region were studied and compared for the period between 1997-2004, according to the data of National Public Health and Medical Officer Service. These data were then compared with the national average mortality data of Hungarian Central Statistical Office. With the help of our own computerized database we examined this period and compared the number of the completed invasive interventions to the mortality statistics. In the first full year, in 1998, we completed 82 primer and 283 elective PCIs; these number increased to 318 and 1265 by year 2005. At the same time, significant decrease of acute infarction related mortality was detectable among men of the Zalaegerszeg micro-region, comparing to the national average (pheart attack intervention care improved the area's mortality statistics significantly, comparing to the national average. The skilled work of the experienced team means an important advantage to the patients in Zalaegerszeg micro-region.

  4. Impact of coronary heart disease on cognitive decline in Alzheimer's disease: a prospective longitudinal cohort study in primary care.

    Science.gov (United States)

    Bleckwenn, Markus; Kleineidam, Luca; Wagner, Michael; Jessen, Frank; Weyerer, Siegfried; Werle, Jochen; Wiese, Birgitt; Lühmann, Dagmar; Posselt, Tina; König, Hans-Helmut; Brettschneider, Christian; Mösch, Edelgard; Weeg, Dagmar; Fuchs, Angela; Pentzek, Michael; Luck, Tobias; Riedel-Heller, Steffi G; Maier, Wolfgang; Scherer, Martin

    2017-02-01

    Arteriosclerotic disorders increase the risk of dementia. As they have common causes and risk factors, coronary heart disease (CHD) could influence the course of dementia. To determine whether CHD increases the speed of cognitive decline in Alzheimer's disease, and to discuss the potential for secondary cardiovascular prevention to modify this decline. Prospective multicentre cohort study in general practices in six cities in Germany. Participants were patients with probable mild-to-moderate Alzheimer's dementia or mixed dementia (n = 118; mean age 85.6 [±3.4] years, range 80-96 years). The authors assessed the presence of CHD according to the family physicians' diagnosis. Cognitive performance was measured during home visits for up to 3 years in intervals of 6 months, using Mini Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SoB). The authors also recorded whether patients died in the observation period. At baseline, 65 patients (55%) had CHD and/or a heart condition following a myocardial infarction. The presence of CHD accelerated cognitive decline (MMSE, Pcognitive-functional ability (CDR-SoB, Pcognitive decline in older patients with late-onset dementia. The dementia process might therefore be positively influenced by cardiovascular prevention, and this possible effect should be further investigated. © British Journal of General Practice 2017.

  5. Implementing a pharmacy resident run transition of care service for heart failure patients: Effect on readmission rates.

    Science.gov (United States)

    Salas, Cristina M; Miyares, Marta A

    2015-06-01

    Heart failure (HF) is a leading cause of hospital readmissions adversely affecting resources and hospital reimbursements. The purpose of this study was to optimize medication therapy, provide patient education and facilitate discharge and follow-up through the creation of a pharmacy resident managed HF transition service with the intention of decreasing readmission rates. A 6-month prospective, single center pilot study was conducted by a pharmacy resident to decrease readmission rates in patients with HF. Patients were identified through emergency department admission reports and direct requests from discharge nurses. The pharmacy resident provided patients with tailored medication and disease state counseling, ensured obtainment of discharge medications and performed follow up telephone calls for appointment reminders and further counseling. The primary outcome measured was readmission rate at 30 days. Secondary outcomes were number of patients requesting safety net medications, reason for readmission(s), and appointment compliance. Thirty patients were enrolled in the program. The 30-day heart failure readmission rate decreased from 28.1% to 16.6%. Eighty-eight percent of patients attended their follow up appointments. A reduction in readmission rate was achieved through this pharmacy resident-run HF transition service. The majority of patients attended follow-up visits and financial appointments after discharge. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  6. Prevalence and inter-relationship of different Doppler measures of dyssynchrony in patients with heart failure and prolonged QRS: a report from CARE-HF

    Directory of Open Access Journals (Sweden)

    Maru Fikru

    2009-01-01

    Full Text Available Abstract Background Cardiac resynchronisation therapy (CRT improves mortality and morbidity in heart failure patients with wide QRS. Observational studies suggest that patients having more left ventricular dyssynchrony pre-implantation obtain greater benefit on ventricular function and symptoms with CRT. Aim To provide an analysis of the prevalence and type of dyssynchrony in patients included in the CARE-HF trial. Methods 100 patients 67 (58 to 71 years were examined with echocardiography including tissue doppler imaging before receiving a CRT-pacemaker. Atrio-ventricular dyssynchrony (LVFT/RR was defined as left ventricular filling time 40 ms. Intra-ventricular (regional dyssynchrony in a 16-segment model was expressed either as a delayed longitudinal contraction (DLC during the postsystolic phase or by tissue synchronisation imaging (TSI with a predefined time-difference in systolic maximal velocities >85 ms. Results LVFT/RR was present in 34% and IVMD in 60% of patients while intra-ventricular dyssynchrony was present in 85% (DLC and 86% (TSI with a high agreement between the measures (Kappascore 0.86–1.00, indicating the methods being interchangeable. Patients with cardiomyopathy (53% were more likely to have LVFT/RR Conclusion The prevalence of intra-ventricular dyssynchrony is high in patients with heart failure, wide QRS and depressed systolic function. Most important, TSI appears to be a fast and reliable method to identify patients with intra-ventricular dyssynchrony likely to benefit from CRT.

  7. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Cruz-Flores, Salvador; Rabinstein, Alejandro; Biller, Jose; Elkind, Mitchell S V; Griffith, Patrick; Gorelick, Philip B; Howard, George; Leira, Enrique C; Morgenstern, Lewis B; Ovbiagele, Bruce; Peterson, Eric; Rosamond, Wayne; Trimble, Brian; Valderrama, Amy L

    2011-07-01

    Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage

  8. Heart Attack

    Science.gov (United States)

    Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly ... it's important to know the symptoms of a heart attack and call 9-1-1 if you or ...

  9. Heart Transplantation

    Science.gov (United States)

    A heart transplant removes a damaged or diseased heart and replaces it with a healthy one. The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed. The ...

  10. Heart Diseases

    Science.gov (United States)

    ... re like most people, you think that heart disease is a problem for others. But heart disease is the number one killer in the U.S. ... disability. There are many different forms of heart disease. The most common cause of heart disease is ...

  11. Combined heart-kidney transplantation after total artificial heart insertion.

    Science.gov (United States)

    Ruzza, A; Czer, L S C; Ihnken, K A; Sasevich, M; Trento, A; Ramzy, D; Esmailian, F; Moriguchi, J; Kobashigawa, J; Arabia, F

    2015-01-01

    We present the first single-center report of 2 consecutive cases of combined heart and kidney transplantation after insertion of a total artificial heart (TAH). Both patients had advanced heart failure and developed dialysis-dependent renal failure after implantation of the TAH. The 2 patients underwent successful heart and kidney transplantation, with restoration of normal heart and kidney function. On the basis of this limited experience, we consider TAH a safe and feasible option for bridging carefully selected patients with heart and kidney failure to combined heart and kidney transplantation. Recent FDA approval of the Freedom driver may allow outpatient management at substantial cost savings. The TAH, by virtue of its capability of providing pulsatile flow at 6 to 10 L/min, may be the mechanical circulatory support device most likely to recover patients with marginal renal function and advanced heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. An end-of-life care nurse service for people with COPD and heart failure: stakeholders' experiences.

    Science.gov (United States)

    Johnston, Bridget; Coole, Carolyn; Jay Narayanasamy, Melanie

    2016-11-02

    End-of-life care (EOLC) has historically been associated with cancer care. However, demographic changes indicate that future provision must also cater for other long term conditions (LTC). An EOLC-LTC service, delivered by palliative care nurses, is currently being piloted in one area in the East Midlands with patients with cardiac and respiratory disease. In order to inform future commissioning, it is important to gain the views and experiences of those involved with the service. This study aimed to explore patients, and their partners, views and experiences of the EOLC-LTC service. Semi-structured interviews were used as part of a case study design, involving six cases. Each case consisted of the patient, their nominated family member/carer and key healthcare professionals involved in their care as identified by the patient. This paper reports on the findings from the interviews conducted with the six patients and their family member/carers. Data were analysed thematically. From the interviews, the following themes were identified: experiences managing a long term cardio-respiratory condition, the nurse service, building a close/therapeutic relationship and fragmentation and integration. This study has shown that the EOLC-LTC service is welcomed and highly regarded by patients and their family members/carers. Further studies are required to explore the views and experiences of other key stakeholders and to evaluate how well the pilot operates within the wider care pathway.

  13. Alternativas de financiamiento de la atención médica en América Latina y el Caribe Alternatives for the financing of health care in Latin America and the Caribbean

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Coelho Campino

    1995-06-01

    Full Text Available Dada la magnitud del problema de salud en los paises de America Latina y el Caribe, el déficit de recursos financieros necesarios para proveer atención médica no se puede cubrir a través de aumentos en los precios, o adoptando medidas como pago por servicio o cobro por los costos de los servicios. Es necesario recurrir a la política fiscal. Se demuestra que es posible aumentar los recursos disponibles para la atención médica, tanto por el aumento en la recaudación de impuestos, como por la toma de decisión política de aumentar los ingresos del gobierno destinados a financiar la atención médica. Se revisa la experiencia de los Fondos de Emergencia Social y de las operaciones de cambio de deuda por salud como importantes fuentes adicionales de recursos especialmente para financiar la inversión.Dada a magnitude do problema de saúde nos países da América Latina e do Caribe, não é possível cobrir o déficit de recursos financeiros necessários para prover assistência médica através de aumentos nos preços, ou com a adoção de medidas como o pagamento por serviços ou a cobrança do custo dos serviços. Faz-se necessário recorrer à política fiscal. Foi mostrado que é possível aumentar os recursos disponíveis para assistência médica, tanto por meio do aumento na arrecadação de impostos, quanto pela tomada da decisão política de aumentar a parcela da receita do Governo, destinada a financiar a assistência médica. Foi revista a experiência dos Fundos de Emergência Social e das operações de troca de dívida por projetos na área de saúde como importantes fontes adicionais de recursos, especialmente para financiar o investimento.Latin America and the Caribbean (LAC countries are experiencing both an economic crisis and a crisis in the public sector. As a result it is impossible to increase the amount of resources available to the health sector, unless there is a drastic restructuring of the way in which financing

  14. The REFER (REFer for EchocaRdiogram protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design

    Directory of Open Access Journals (Sweden)

    Tait Lynda

    2012-10-01

    Full Text Available Abstract Background Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge. All patients with suspected heart failure should be diagnosed using objective tests such as echocardiography, but it is expensive, often delayed, and limited by the significant skill shortage of trained echocardiographers. Alternative approaches for diagnosing heart failure are currently limited. Clinical decision tools that combine clinical signs, symptoms or patient characteristics are designed to be used to support clinical decision-making and validated according to strict methodological procedures. The REFER Study aims to determine the accuracy and cost-effectiveness of our previously derived novel, simple clinical decision rule, a natriuretic peptide assay, or their combination, in the triage for referral for echocardiography of symptomatic adult patients who present in general practice with symptoms suggestive of heart failure. Methods/design This is a prospective, Phase II observational, diagnostic validation study of a clinical decision rule, natriuretic peptides or their combination, for diagnosing heart failure in primary care. Consecutive adult primary care patients 55 years of age or over presenting to their general practitioner with a chief complaint of recent new onset shortness of breath, lethargy or peripheral ankle oedema of over 48 hours duration, with no obvious recurrent, acute or self-limiting cause will be enrolled. Our reference standard is based upon a three step expert specialist consensus using echocardiography and clinical variables and tests. Discussion Our clinical decision rule offers a potential solution to the diagnostic challenge of providing a timely and

  15. Successful Heart Transplant after Ten Hours Out-of-body Time using the TransMedics Organ Care System.

    Science.gov (United States)

    Stamp, Nikki L; Shah, Amit; Vincent, Viji; Wright, Brian; Wood, Clare; Pavey, Warren; Cokis, Chris; Chih, Sharon; Dembo, Lawrence; Larbalestier, Rob

    2015-06-01

    We report the successful transplantation of a heart following an out-of-body time of 611 minutes into a recipient with dilated cardiomyopathy and left ventricular assist device implant. Our patient was urgently waiting for a cardiac transplant whilst receiving LVAD support. Recurrent VF and repeated AICD shocks necessitated this action. Although requiring ECMO and inotropic support in the first 17 hours post-transplant, the patient was discharged from hospital on day 15 post-transplant with normal cardiac function. We report some of the salient points of the process and discuss the utility of this technology to an Australian transplant unit. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

  16. Emerging viruses in Florida and the Caribbean

    Science.gov (United States)

    Multiple thrips-, whitefly- and aphid-transmitted viruses have recently emerged or re-emerged in vegetable and ornamental crops in Florida and the Caribbean. Tomato spotted wilt virus (a thrips-transmitted tospovirus) and Tomato yellow leaf curl virus (a whitefly-transmitted begomovirus) have histor...

  17. Highlight: Canadian and Caribbean parliamentarians discuss open ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-04-14

    Apr 14, 2016 ... A farm to fork approach to nutritious school meals: Tackling childhood obesity in the Caribbean. In St Kitts-Nevis and Trinidad and Tobago, partnerships between the agriculture, health, and education sectors have united in a "Farm to Fork" effo. View moreA farm to fork approach to nutritious school meals: ...

  18. Latin America and the Caribbean | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Long-term sustainability of development in Latin America and the Caribbean through economic growth, equitable access to health and social services, sustainable natural resources, and civil security. And we are ... Honduras. With our partners, IDRC-funded research in Honduras is building robust local leadership capacity.

  19. Caribbean health: Healthy children, healthy nation

    International Development Research Centre (IDRC) Digital Library (Canada)

    Caribbean food groups, balanced diets and portion sizes, healthy snacking, nutrition label reading, physical activity, home gardening, food safety and hygiene as well as cooking methods. Two schools revived school gardens, providing an opportunity to consume their own produce and learn how to grow vegetables and ...

  20. Networks for Development : Caribbean Information and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The second component, Rethinking ICT Policy and Regulation, will examine policymaking and regulation formulation and their implementation across four jurisdictions: Barbados, Jamaica, Trinidad and Tobago, and the Organization of Eastern Caribbean States. All these jurisdictions have implemented ICT reforms with ...

  1. Electronic Government : Caribbean Pilot Project | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Caribbean countries are increasingly adopting information and communication technologies (ICTs) in the process of modernizing their public sectors. In 2003, the Jamaican Customs Authority successfully deployed its Customs Automated Services (CASE) solution, attracting the attention of neighboring countries and the ...

  2. Latin American and Caribbean Environmental Economics Program ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Latin American and Caribbean Environmental Economics Program Phase III. A grant to improve a new generation of Latin American leaders' understanding of how to better manage natural resources will contribute to the region's economic and social development. Earlier IDRC grants helped the Latin American and ...

  3. Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care.

    Science.gov (United States)

    Murchie, Peter; Campbell, Neil C; Ritchie, Lewis D; Deans, H George; Thain, Joan

    2004-10-01

    The long-term effects of disease management programmes for coronary heart disease on health status are unknown. In a randomized trial of nurse-led secondary prevention clinics, we found significantly improved health status at 1 year. Participants were followed-up again at 4 years to determine if improvements had been sustained. Our aim was to evaluate the effects on health of nurse-led clinics for the secondary prevention of coronary heart disease in primary care. A total of 1343 patients with coronary heart disease were randomized to nurse-led secondary prevention clinics or usual care, with follow-up at 1 and 4 years by review of medical case notes and national data sets, and postal questionnaires. The study involved a stratified, random sample of 19 general practices in north-east Scotland. Health status was measured by the SF-36 questionnaire, chest pain by the angina TyPE specification and anxiety and depression by the hospital anxiety and depression scale. At 1 year, there were significant improvements in five of eight SF-36 domains (all functioning scales, pain and general health) in patients randomized to clinics. Role limitations attributed to physical problems improved the most [adjusted difference 8.52, 95% confidence interval (CI) 4.16-12.9]. At 4 years, the intervention group scored higher than control in all domains, but differences were no longer significant. At 1 year, fewer patients in the intervention group reported worsening chest pain (odds ratio 0.59, 95% C1 0.37-0.94). At 4 years, there were no significant differences between the proportion of intervention or control group patients who reported chest pain in the last week or who reported worsening chest pain. No significant effects were observed on anxiety or depression at 1 or 4 years. We have demonstrated previously a significantly greater survival in attendees at nurse-led secondary prevention clinics. Despite this, improvements in health status achieved in the first year of the study were

  4. Improvement of primary care for patients with chronic heart failure: a study protocol for a cluster randomised trial comparing two strategies.

    Science.gov (United States)

    van Lieshout, Jan; Steenkamer, Betty; Knippenberg, Marjan; Wensing, Michel

    2011-03-25

    Many patients with chronic heart failure (CHF), a common condition with high morbidity and mortality rates, receive treatment in primary care. To improve the management of CHF in primary care, we developed an implementation programme comprised of educational and organisational components, with support by a practice visitor and focus both on drug treatment and lifestyle advice, and on organisation of care within the practice and collaboration with other healthcare providers. Tailoring has been shown to improve the success of implementation programmes, but little is known about what would be best methods for tailoring, specifically with respect to CHF in primary care. We describe the study protocol of a cluster randomised controlled trial to examine the effectiveness of tailoring a CHF implementation programme to general practices compared to a standardised way of delivering a programme. The study population will consist of 60 general practitioners (GPs) and the CHF patients they include. GPs are randomised in blocks of four, stratified according to practice size. With a tailored implementation programme GPs prioritise the issues that will form the bases of the support for the practice visits. These may comprise several issues, both educational and organizational.The primary outcome measures are patient's experience of receiving structured primary care for CHF (PACIC, a questionnaire related to the Chronic Care Model), patients' health-related utilities (EQ-5D), and drugs prescriptions usin