Information Visualisation Practices for Improving Patient Readability of Blood Pressure, Health Data, and Health Literacy

Personal health data obtained through self-monitoring is often presented through standardised representations with little intrinsic meaning for those who may need it the most since low health literacy is associated with poor health. By failing to inform users about their health status, these representations can be dangerous, leaving patients feeling lost, confused, anxious, or even depressed. Information Visualisation can play an important role in aiding patients making sense of their health data and health status, as long as it's aligned with their needs, motivations, and goals. Following Human Centred Design practices, user research methods were applied in order to understand the context of self-monitorisation, as well as identifying which metrics differed the most from participants' mental models. Thanks to quantitative data obtained from a survey, Blood Pressure was identified as the most problematic health variable. A series of interviews allowed patients of chronic conditions to vocalize the challenges they faced in the management of their conditions. Taking into account information obtained from previous steps, multiple ways to map blood pressure data onto design elements were explored and different visualisations were designed. Finally, said visualisations were tested through guided interviews with patients with blood pressure problems. Results showed that participants prefered different visualisations for different goals, and enjoyed being able to choose freely from them; participants with lower literacy but who were deeply invested in monitoring their health found tables to be the most informative visualizations; finally, participants identified colour scales as the most intuitive method to represent health status and health risk

Vascular health and mental health in collegiate female varsity athletes, club sport athletes and recreationally active women

The number of women participating in collegiate athletics has increased since Title IX was passed, which supports equal access to men and women in government-funded programs. Female student athletes are under increased pressure to maintain fitness while meeting academic standards, thus resulting in mental health concerns (i.e., depression and anxiety) and related poor lifestyle habits (i.e. problematic alcohol drinking and disturbed sleep quality). While high fitness imparts cardiovascular health benefits, such mental health concerns and poor lifestyle habits negatively impact cardiovascular health. Cardiovascular health is particularly concerning for women, as cardiovascular disease is a leading cause of death in this group and recent data suggest increased rates of cardiovascular health-related hospitalizations in young women. PURPOSE: To compare vascular health, fitness, mental health and lifestyle habits of collegiate varsity athletes, club sport athletes and recreationally active (RA) women. METHODS: Eight Division 1 varsity athletes ( age 20±1 yrs, BMI 24.1±1.6 kg/m2) and 12 club sport athletes (age 20±2 yrs, BMI 24.5±3.2 kg/m2), were matched to 20 RA women (age 20±2 yrs, BMI 24.3±3.0 kg/m2) based on age and height. Cardiovascular health assessment included measures of pulse pressure (PP) and carotid-femoral pulse wave velocity (PWV). Fitness was broadly defined as cardiorespiratory fitness, strength, flexibility and balance assessed using a YMCA Step Test and estimated VO2max, hand grip strength, sit-and-reach and balancing on a firm and foam surface over a force platform, respectively. Generally accepted and validated questionnaires were used to subjectively assess depression, anxiety, alcohol consumption behaviors, sleep quality and physical activity. Physical activity and sleep were further objectively assessed using accelerometry. RESULTS: Varsity athletes had higher PP (p\u3c0.05) but similar aortic stiffness (p\u3e0.05) compared to club and RA. Varsity athletes had greater estimated VO2max and average strength compared to RA (p\u3c0.05). Varsity athletes spent less time in sedentary and greater time in vigorous activity assessed through the analysis of accelerometer data compared to both the club and RA women (p\u3c0.05). There were no differences in anxiety or depression scores or lifestyle habits between the varsity athletes and RA. CONCLUSION: Despite having greater levels of fitness, more optimal physical activity habits and comparable mental health as female club sport athletes or non-athletes, female collegiate varsity athletes had higher pulse pressure. Given that the higher PP occurred concomitant with similar aortic stiffness and mean arterial pressure, we suggest that increased PP in this setting is a reflection of an exercise adaption related to cardiac structure and function

Implementing a Self-measured Blood Pressure Monitoring Process

Practice Problem: Because of the prevalence of hypertension worldwide, it is prudent for all patients to have the knowledge and ability to self-monitor their blood pressure. Patients monitoring their own blood pressure and communicating the readings with healthcare providers facilitates a more comprehensive plan of care. PICOT: The PICOT question that guided this project was: In adults 18-90 years old with primary hypertension (P), will a self-measured blood pressure monitoring that includes a monthly telehealth visit with a provider (I), compared to blood pressure monitoring at routine office visits (C), decrease patients\u27 systolic blood pressure readings by five mmHg (O) within 8 weeks (T)? Evidence: Research shows that self-measured blood pressure monitoring reduces blood pressure, possibly because treatment adherence is improved due to daily monitoring and reporting the reading to a provider. Intervention: Twenty participants took their blood pressure at home with a verified monitor and entered the readings into the patient portal for the provider to review for 8 weeks. Pre and post-project blood pressure readings were analyzed for home monitoring effectiveness. Outcome: A two-tailed paired samples t-test was used to show that the mean of the pre-project systolic blood pressure was significantly higher (143.60 mmHg) than the mean of the post-project systolic blood pressure (130.50 mmHg). Clinical significance was observed by lower systolic blood pressure readings of the hypertensive participants by the end of the project. Conclusion: By monitoring at home daily, the patient is aware of their blood pressure readings and understands when treatment changes are necessary. This increases patient engagement in the self-care of hypertension while reducing their blood pressure

Aerospace Medicine and Biology: A continuing bibliography with indexes, supplement 144

This bibliography lists 257 reports, articles, and other documents introduced into the NASA scientific and technical information system in July 1975

Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community

<p>Abstract</p> <p>Background</p> <p>Latinos comprise the largest racial/ethnic group in the United States and have 2–3 times the prevalence of type 2 diabetes mellitus as Caucasians.</p> <p>Methods and design</p> <p>The Lawrence Latino Diabetes Prevention Project (LLDPP) is a community-based translational research study which aims to reduce the risk of diabetes among Latinos who have a ≥ 30% probability of developing diabetes in the next 7.5 years per a predictive equation. The project was conducted in Lawrence, Massachusetts, a predominantly Caribbean-origin urban Latino community. Individuals were identified primarily from a community health center's patient panel, screened for study eligibility, randomized to either a usual care or a lifestyle intervention condition, and followed for one year. Like the efficacious Diabetes Prevention Program (DPP), the LLDPP intervention targeted weight loss through dietary change and increased physical activity. However, unlike the DPP, the LLDPP intervention was less intensive, tailored to literacy needs and cultural preferences, and delivered in Spanish. The group format of the intervention (13 group sessions over 1 year) was complemented by 3 individual home visits and was implemented by individuals from the community with training and supervision by a clinical research nutritionist and a behavioral psychologist. Study measures included demographics, Stern predictive equation components (age, gender, ethnicity, fasting glucose, systolic blood pressure, HDL-cholesterol, body mass index, and family history of diabetes), glycosylated hemoglobin, dietary intake, physical activity, depressive symptoms, social support, quality of life, and medication use. Body weight was measured at baseline, 6-months, and one-year; all other measures were assessed at baseline and one-year. All surveys were orally administered in Spanish.</p> <p>Results</p> <p>A community-academic partnership enabled the successful recruitment, intervention, and assessment of Latinos at risk of diabetes with a one-year study retention rate of 93%.</p> <p>Trial registration</p> <p>NCT00810290</p

Hypertension Management Through Patient Education

Hypertension serves as a common diagnosis among Americans, and its management to prevent further cardiovascular complications remains as an organizational goal. To prevent complications, the goal of a Primary Care Provider’s patient panel maintaining a blood pressure less than 140/90 has been established on the organization’s national office. In the Primary Care Clinic, an interdisciplinary team consisting of a Registered Nurse, Clinical Psychologist, and Cardiologist implemented a group education class aimed at a Hypertensive Veteran cohort. The purpose of this project is to improve self-management behaviors in the Veteran population, and to help increase the hypertension performance metric by 2% one month after class implementation. Blood pressure readings were measured before and after the class, as well as the percentage of well-controlled hypertensive patients on the Primary Care Dashboard. Data collection revealed a 2.2% performance increase one month after the class implementation; this reflects an improvement in the Primary Care Provider’s ability to manage his hypertensive cohort, while also indicating an overall increase in the number of hypertensive patients whose systolic blood pressure was lower than 140 mmHg, and diastolic blood pressure lower than 90 mmHg

Interventions used to improve control of blood pressure in patients with hypertension.

BACKGROUND: It is well recognized that patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals - a condition labeled as "uncontrolled" hypertension. The optimal way in which to organize and deliver care to patients who have hypertension so that they reach treatment goals has not been clearly identified. OBJECTIVES: To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension. To evaluate the effectiveness of reminders on improving the follow-up of patients with hypertension. SEARCH STRATEGY: All-language search of all articles (any year) in the Cochrane Controlled Trials Register (CCTR), Medline and Embase from June 2000. SELECTION CRITERIA: Randomized controlled trials (RCTs) of patients with hypertension that evaluated the following interventions: (1) self-monitoring (2) educational interventions directed to the patient (3) educational interventions directed to the health professional (4) health professional (nurse or pharmacist) led care (5) organisational interventions that aimed to improve the delivery of care (6) appointment reminder systems. Outcomes assessed were: (1) mean systolic and diastolic blood pressure( 2) control of blood pressure (3) proportion of patients followed up at clinic. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently and in duplicate and assessed each study according to the criteria outlined by the Cochrane Collaboration Handbook. MAIN RESULTS: 56 RCTs met our inclusion criteria. The methodological quality of included studies was variable. An organized system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure (weighted mean difference -8.2/-4.2 mmHg, -11.7/-6.5 mmHg, -10.6/-7.6 mmHg for 3 strata of entry blood pressure) and all-cause mortality at five years follow-up (6.4% versus 7.8%, difference 1.4%) in a single large RCT- the Hypertension Detection and Follow-Up study. Other interventions had variable effects. Self-monitoring was associated with moderate net reduction in diastolic blood pressure (weighted mean difference (WMD): -2.0 mmHg, 95%CI: -2.7 to -1.4 mmHg, respectively. Appointment reminders increased the proportion of individuals who attended for follow-up. RCTs of educational interventions directed at patients or health professionals were heterogeneous but appeared unlikely to be associated with large net reductions in blood pressure by themselves. Health professional (nurse or pharmacist) led care may be a promising way of delivering care, with the majority of RCTs being associated with improved blood pressure control, but requires further evaluation. AUTHORS' CONCLUSIONS: Family practices and community-based clinics need to have an organized system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels

The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol

Background: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. Methods: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. Discussion: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. Trial registration: NCT03264443. Registered on 29 August, 2017

Aerospace medicine and biology: A continuing bibliography with indexes, supplement 183

This bibliography lists 273 reports, articles, and other documents introduced into the NASA scientific and technical information system in July 1978