The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.Cardiolog

How health care professionals evaluate a digital intervention to improve medication adherence: Qualitative exploratory study

Background: Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence.Objective: The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example.Methods: A Web-based prototype of the eHealth app—MIK—was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians’ evaluations.Results: On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient’s understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow.Conclusions: The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM.Applied Ergonomics and Desig

Development of floating rafts after the rewetting of cut-over bogs: the importance of peat quality

Contains fulltext : 60321.pdf (publisher's version ) (Closed access)The usual method of restoring cut-over bogs is to rewet the peat surface. but this often leads to the remaining peat layers being deeply inundated. For Sphagnum-dominated vegetation to develop at deeply inundated locations. it is important for floating rafts of buoyant residual peat to develop. In this study. the chemical and physical characteristics of buoyant and inundated peat collected from rewetted cut-over bog were compared. In general. buoyant peat was poorly humified: high methane (CH4) production rates (greater than or equal to2 mumol g(-1) DW day(-1)) were important to ensure buoyancy. Although the peat water CH4 concentrations increased with depth. the CH4 production rates were higher in the uppermost peat layers. High CH4 production rates were related positively with P concentrations and negatively with lignin concentrations. The pH to bulk density ratio (greater than or equal to0.05) also appeared to be a good indicator of CH4 production rates, providing an easy and cheap way to measure. the variable for restoration practitioners. Our results indicated that analysing certain simple characteristics of the residual peat can greatly improve the success of the rewetting measures taken in cut-over bogs. If the analysis reveals that the residual peat is unsuitable for floating raft formation, deep inundation is inappropriate unless suitable peat from other locations can be introduced