A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

Background: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes. Methods: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework. Results: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes. Conclusion: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support

EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened

Effects of rehabilitation based on endurance training in adolescent girls with surgically treated scoliosis

The aim of the study was to investigate whether appropriate rehabilitation program in the postoperative period can further improve pulmonary function and increase physical performance in patients with idiopathic scoliosis.The study group consisted of 16 adolescent girls in average 2.3 years after surgical treatment of scoliosis. Patients participated in a 4-week, intensive rehabilitation program. Before the rehabilitation program (Term I) and directly after completing it (Term II) patients performed a spiroergometry with intensity increasing up to the ventilatory threshold and a resting spirometry to assess their physical performance. Additionally, patients’ maximal oxygen uptake (VO2max) was determined indirectly. The results of the exercise test performed at the beginning of the study were used to select individual loads for the endurance training. The workload at which the ventilatory threshold was reached and the value of VO2max were significantly higher during the ergometry at Term II, which indicates that patients’ physical performance improved during the rehabilitation program. Ventilatory and circulatory parameters did not differ between exercise tests at Term I and II. Similar response of the cardiopulmonary system to submaximal exercise at greater work load proves increased physical performance. Vital capacity was similar at Term I and II. Maximal voluntary ventilation increased significantly following the rehabilitation program, but was still lower than the predicted value. Rehabilitation training in girls after surgical treatment of scoliosis caused an important increase in the physical performance capacity, which most probably was the result of the endurance training of individually selected intensity

Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia

Tomasz Nowak,1 Agnieszka Neumann-Podczaska,2 Ewa Deskur-Śmielecka,1 Arkadiusz Styszyński,1 Katarzyna Wieczorowska-Tobis1 1Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland; 2Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznań, Poland Introduction: In patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia.Patients and methods: The research was conducted in 2 nursing home facilities in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen–Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed.Results: Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) - as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p<0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p<0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia.Conclusion: Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential. Keywords: pain, analgesics, nursing home residents, older individuals, Abbey Pain Scale, CMA

The effect of endurance training on cell metabolism and exercise tolerance in patients with ischemic heart disease

We have investigated the effect of endurance training on cell metabolism and exercise tolerance in patients with ischemic heart disease. Study population consisted of 24 survivors of myocardial infarction. Patients were assigned to the training group (n=18, mean age 48.2 years) or to the control group (n=6, mean age 42.6 years). Directly before (ExTest I) and after completing a 3-week endurance training program (ExTest II) patients performed bicycle ergometry with computer analysis of ventilatory expired gas (CardioO2, Medical Graphics Corporation). The exercise intensity increased gradually until ventilatory threshold was reached. ExTest II was finished at the same workload level as ExTest I. ECG was recorded and blood pressure was assessed during each ergometry. Prior to and 3 minutes after finishing each test, capillary blood samples were taken for measurements of acid-base equilibrium parameters and lactate concentrations and venous blood samples were collected for assessment of oxypurines and uric acid levels (HPLC method). The training consisted of five 40-min sessions of continuos working on a bicycle ergometer weekly. The workload was 25 W lower than the load at which ventilatory threshold had been reached by the patient. Subjects in the control group did not participate in endurance training. During exercise tests performed after the rehabilitation program, heart rate and rate-pressure product at particular workload were lower than on admission. Similarly, the increases in lactate concentrations and changes in base excess were reduced during ExTest II. The oxypurines pool was reduced after the training, which reflects improvement in cell metabolism. No influence of training on uric acid concentrations was observed