12,907 research outputs found
Internet-based training of coronary artery patients: the Heart Cycle Trial
© 2016, Springer Japan. Low adherence to cardiac rehabilitation (CR) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs. The main objective of this study was to evaluate the feasibility of a smartphone-guided training system (GEX) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease (CAD). A prospective, randomized, international, multi-center study comparing CR delivered by conventional means (CG) or by remote monitoring (IG) using a new training steering/feedback tool (GEx System). This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity, arrhythmias and adherence to training prescriptions, wirelessly via the internet, to a medical team that provided feedback and adjusted training prescriptions. Exercise capacity was evaluated prior to and 6 months after intervention. 118 patients (58 ± 10 years, 105 men) with CAD referred for CR were randomized (IG: n = 55, CG: n = 63). However, 15 patients (27 %) in the IG and 18 (29 %) in the CG withdrew participation and technical problems prevented a further 21 patients (38 %) in the IG from participating. No training-related complications occurred. For those who completed the study, peak VO 2 improved more (p = 0.005) in the IG (1.76 ± 4.1 ml/min/kg) compared to CG (â0.4 ± 2.7 ml/min/kg). A newly designed system for home-based CR appears feasible, safe and improves exercise capacity compared to national CR. Technical problems reflected the complexity of applying remote monitoring solutions at an international level
Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart'): study protocol. Secondary prevention program for myocardial infarction patients
Background: \ud
Coronary heart disease (CHD) is a significant cause of health and economic burden. Secondary prevention programs play a pivotal role in the treatment and management of those affected by CHD although participation rates are poor due to patient, provider, health system and societal-level barriers. As such, there is a need to develop innovative secondary prevention programs to address the treatment gap. Telephone-delivered care is convenient, flexible and has been shown to improve behavioural and clinical outcomes following myocardial infarction (MI). This paper presents the design of a randomised controlled trial to evaluate the efficacy of a six-month telephone-delivered secondary prevention program for MI patients (ProActive Heart).\ud
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Methods:\ud
550 adult MI patients have been recruited over a 14 month period (December 2007 to January 2009) through two Brisbane metropolitan hospitals, and randomised to an intervention or control group (n = 225 per group). The intervention commences within two weeks of hospital discharge delivered by study-trained health professionals ('health coaches') during up to 10 Ă 30 minute scripted telephone health coaching sessions. Participants also receive a ProActive Heart handbook and an educational resource to use during the health coaching sessions. The intervention focuses on appropriate modification of CHD risk factors, compliance with pharmacological management, and management of psychosocial issues. Data collection occurs at baseline or prior to commencement of the intervention (Time 1), six months follow-up or the completion of the intervention (Time 2), and at 12 months follow-up for longer term outcomes (Time 3). Primary outcome measures include quality of life (Short Form-36) and physical activity (Active Australia Survey). A cost-effective analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government.\ud
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Discussion: The results of this study will provide valuable new information about an innovative telephone-delivered cost-effective secondary prevention program for MI patients
HeartCycle: User interaction and patient education
Cardiovascular Diseases are the most prevalent and serious chronic conditions existing nowadays. They are the primary cause of death in the world and generate enormous expenditures to the health systems. Tele-monitoring and personal health systems have proven to be good options for tackling this situation; however they are still lacking many functionalities. It is necessary to find solutions that allow health professionals to follow up patients more closely and efficiently, while reducing the non-adherence of patients to the treatment regime. HeartCycle research project (partially funded by the European Commission) has developed a personal health system for cardiovascular diseases management with the aim to address this problem. This paper describes the Patient Loop of this solution, including the different components, the adopted user interaction, and the implemented patients education and coaching strategy
Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart'): study protocol. Secondary prevention program for myocardial infarction patients
Background: Coronary heart disease (CHD) is a significant cause of health and economic burden. Secondary prevention programs play a pivotal role in the treatment and management of those affected by CHD although participation rates are poor due to patient, provider, health system and societal-level barriers. As such, there is a need to develop innovative secondary prevention programs to address the treatment gap. Telephone-delivered care is convenient, flexible and has been shown to improve behavioural and clinical outcomes following myocardial infarction (MI). This paper presents the design of a randomised controlled trial to evaluate the efficacy of a six-month telephone-delivered secondary prevention program for MI patients (ProActive Heart). Methods: 550 adult MI patients have been recruited over a 14 month period (December 2007 to January 2009) through two Brisbane metropolitan hospitals, and randomised to an intervention or control group (n = 225 per group). The intervention commences within two weeks of hospital discharge delivered by study-trained health professionals ('health coaches') during up to 10 Ă 30 minute scripted telephone health coaching sessions. Participants also receive a ProActive Heart handbook and an educational resource to use during the health coaching sessions. The intervention focuses on appropriate modification of CHD risk factors, compliance with pharmacological management, and management of psychosocial issues. Data collection occurs at baseline or prior to commencement of the intervention (Time 1), six months follow-up or the completion of the intervention (Time 2), and at 12 months follow-up for longer term outcomes (Time 3). Primary outcome measures include quality of life (Short Form-36) and physical activity (Active Australia Survey). A cost-effective analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the government. Discussion: The results of this study will provide valuable new information about an innovative telephone-delivered cost-effective secondary prevention program for MI patients
East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series
Academic geriatric medicine in Leicester
.
There has never been a better time to consider joining us. We have recently appointed a
Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton,
who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic
opportunities to support students in their academic pursuits through a well-established
intercalated BSc programme, and routes on through such as ACF posts, and a successful
track-record in delivering higher degrees leading to ACL post. We collaborate strongly
with Health Sciences, including academic primary care. See below for more detail on our
existing academic set-up.
Leicester Academy for the Study of Ageing
We are also collaborating on a grander scale, through a joint academic venture focusing
on ageing, the âLeicester Academy for the Study of Ageingâ (LASA), which involves the
local health service providers (acute and community), De Montfort University; University
of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK.
Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been
joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen
Harrison Dening has also recently been appointed an Honorary Chair.
LASA aims to improve outcomes for older people and those that care for them that takes
a person-centred, whole system perspective. Our research will take a global perspective,
but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland,
including building capacity. We are undertaking applied, translational, interdisciplinary
research, focused on older people, which will deliver research outcomes that address
domains from: physical/medical; functional ability, cognitive/psychological; social or
environmental factors. LASA also seeks to support commissioners and providers alike for
advice on how to improve care for older people, whether by research, education or
service delivery. Examples of recent research projects include: âLocal History CafĂ©â
project specifically undertaking an evaluation on loneliness and social isolation; âBetter
Visitsâ project focused on improving visiting for family members of people with dementia
resident in care homes; and a study on health issues for older LGBT people in Leicester.
Clinical Geriatric Medicine in Leicester
We have developed a service which recognises the complexity of managing frail older
people at the interface (acute care, emergency care and links with community services).
There are presently 17 consultant geriatricians supported by existing multidisciplinary
teams, including the largest complement of Advance Nurse Practitioners in the country.
Together we deliver Comprehensive Geriatric Assessment to frail older people with
urgent care needs in acute and community settings.
The acute and emergency frailty units â Leicester Royal Infirmary
This development aims at delivering Comprehensive Geriatric Assessment to frail older
people in the acute setting. Patients are screened for frailty in the Emergency
Department and then undergo a multidisciplinary assessment including a consultant
geriatrician, before being triaged to the most appropriate setting. This might include
admission to in-patient care in the acute or community setting, intermediate care
(residential or home based), or occasionally other specialist care (e.g. cardiorespiratory).
Our new emergency department is the countyâs first frail friendly build and includes
fantastic facilities aimed at promoting early recovering and reducing the risk of hospital
associated harms.
There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we
have been examining geriatric outreach to oncology and surgery as part of an NIHR
funded study.
We are home to the Acute Frailty Network, and those interested in service developments
at the national scale would be welcome to get involved.
Orthogeriatrics
There are now dedicated hip fracture wards and joint care with anaesthetists,
orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone
disease that run clinics.
Community work
Community work will consist of reviewing patients in clinic who have been triaged to
return to the community setting following an acute assessment described above.
Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will
work closely with local GPs with support from consultants to deliver post-acute, subacute,
intermediate and rehabilitation care services.
Stroke Medicine
24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK
and along with the high standard of vascular surgery locally means one of the best
performances regarding carotid intervention
Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study
BACKGROUND: Physical training has beneficial effects on exercise capacity, quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation. However, cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period. Home-based training has the potential to increase cardiac rehabilitation uptake, and was shown to be safe and effective in improving short-term exercise capacity. Long-term effects on physical fitness and activity, however, are disappointing. Therefore, we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home. In this way, we aim to improve self-management skills like self-efficacy and action planning for independent exercise and, consequently, improve long-term effectiveness with respect to physical fitness and physical activity. In addition, we aim to compare costs of this strategy with centre-based cardiac rehabilitation. METHODS/DESIGN: This randomized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular, 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention. The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment. Participants are instructed to train at 70-85% of their maximal heart rate for 45â60Â minutes, twice a week. Patients receive individual coaching by telephone once a week, based on measured heart rate data that are shared through the internet. Primary endpoints are physical fitness and physical activity, assessed at baseline, after 12Â weeks and after one year. Physical fitness is expressed as peak oxygen uptake, assessed by symptom limited exercise testing with gas exchange analysis; physical activity is expressed as physical activity energy expenditure, assessed by tri-axial accelerometry and heart rate measurements. Secondary endpoints are training adherence, quality of life, patient satisfaction and cost-effectiveness. DISCUSSION: This study will increase insight in long-term effectiveness and costs of home-based cardiac rehabilitation with telemonitoring guidance. This strategy is in line with the trend to shift non-complex healthcare services towards patientsâ home environments. TRIAL REGISTRATION: Dutch Trial Register: NTR3780. Clinicaltrials.gov register: NCT0173241
Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions
This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers
Clinical highlights: messages from Munich
This article reviews a selection of presentations in the area of clinical problems that were presented at the 2014 European Respiratory Society International Congress in Munich, Germany. We review the most recent and relevant topics of interest in the area of clinical respiratory medicine, encompassing novel reports and studies that are of particular interest to healthcare professionals. Topics ranging from basic science to translation research are presented and discussed in the context of the most up-to-date literature. In particular, the reviewed topics deal with chronic obstructive pulmonary disease and asthma, idiopathic pulmonary fibrosis (pathogenesis and therapy), advances in functional chest imaging, interventional pulmonology, pulmonary rehabilitation, and chronic care
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