Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

Background: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its’ benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. Methods: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. Results: The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95±0.69 (mean ± standard deviation), 5.33±1.12 and 5.64±1.08, respectively. Conclusions: Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs

The Household Economy Approach. Managing the impact of climate change on poverty and food security in developing countries

Climate change is expected to have severe effects on the populations of developing countries because many of these depend heavily on agriculture for income, have large impoverished rural populations which rely on agriculture for subsistence, and are financially and technically least equipped to adapt to changing conditions. Planning to target measures to support adaptation to reduce the impact of climate change on poverty and food insecurity requires methods of identifying vulnerable households. This paper describes an established approach to vulnerability assessment, the ‘Household Economy Approach’ (HEA) and its potential application to the management of climate change in developing countries. The HEA is widely used by Governments and others, chiefly in Africa, for the assessment of household vulnerability to poverty and food security. HEA uses a model based on Amartya Sen’s entitlement theory and detailed social and economic data to simulate the impact of weather related, price, policy and other shocks on household income and food access, to provide information for decision making. In developing countries climate change will be experienced in terms of increased climate variability and an increased frequency of extreme events. HEA provides a way of managing the effects of year to year shocks to prevent impoverishment and the erosion of household resilience. It also provides the information needed to develop scenarios to support the design of policies to support longer term adaptation. HEA data has already been collected for large areas of Africa

Peer estimation of lack of professionalism correlates with low Conscientiousness Index scores

Context Measures of professionalism in undergraduate medical students are generally subjective in nature, and based on limited observations of behaviours in observed settings. We have previously described an objective scalar measure of conscientiousness over many occasions, and shown that it correlates with independent faculty estimates of students' professionalism. In this study we test the hypothesis that these measures of conscientiousness relate to independent peer estimates of professionalism, and explore the relationships between conscientiousness, and gender and educational background. Methods Medical students in Years 1 and 2 of an undergraduate programme were invited to estimate the professionalism of fellow students using a peer nomination approach. The correlation with the Conscientiousness Index (CI) for each student receiving nominations was explored statistically. Male and female students, from three educational backgrounds, were also compared on the basis of their CI scores. Developmental properties were considered by comparing Year 2 students' CI scores with their corresponding Year 1 performance. Results There was a statistically significant negative correlation between CI scores and nominations for lack of professionalism. No differences were observed between male and female students. There were occasional differences between students of different educational backgrounds, but the sample sizes of some groups were small and we would not wish to over-interpret these data. Conclusions These results support the use of the CI as a scalar, objective potential measure of professionalism, although the observations require repetition elsewhere and over an extended period of time in order to determine the predictive value of this approach