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

Effect of Cyclosporin and Amlodipine on growth and collagen production of human gingival fibroblasts

Drug-induced gingival overgrowth is a disfiguring condition that is a side effect encountered in susceptible responder patients common to three groups of drugs - immunosupressants, calcium channel blockers and anticonvulsant agents. The altered overgrown gingiva can be aesthetically displeasing but in severe cases it can cause functional problems and such patients may eventually require excision of excess tissue. The underlying mechanisms that mediate drug-induced gingival overgrowth is uncertain and the various investigations into the pathogenesis of this disease suggest that it is multifactorial. This study investigated the effects of exogenous addition of cycJosporin and amlodipine on the growth and proliferation of human gingival fibroblasts and the production of collagen by these cells. Results showed that these drugs have a direct stimulatory effect on the gingival fibroblasts of responder patients in vitro and there seems to be a synergistic effect between the two drugs. Findings of this study have important relevance as it suggests that fibroblast proliferation and collagen production must play a significant role in the pathogenesis of drug-induced gingival overgrowth.Dissertation (MSc (Odontology))--University of Pretoria, 2006.Dental Management Sciencesunrestricte

Evaluation of information and communication technology platforms to improve self-management of chronic disease

One of the major epidemiologic trends of the current century is the rise of chronic diseases in Australia and globally. Increasing prevalence of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) is placing enormous financial and societal burden on the economy of many countries. To address the spiralling demand on health service resources, there is an urgent need for alternative, affordable strategies to support the management of these diseases effectively in the community. Historically healthcare systems were designed to manage acute illness, episodically. However, today more than 70% of global health budget expenditure is being directed towards the management of patients with chronic diseases, often with multiple co-morbidities. National and international attention is increasingly being focussed on utilising the advances in information and communication technologies (ICT), to design and develop new platforms for chronic disease management. These include strategies for supporting self-management of chronic conditions and remote monitoring of people’s health in their own homes. The aim of this doctoral research was to evaluate the effectiveness and implementation of a home-based cardiac rehabilitation (CR) program, as well as the implementation of a T2DM self-management intervention. These two programs utilised different technology platforms and were designed to help people more effectively self-manage CVD and T2DM respectively. The Care Assessment Platform (CAP) model was the first to employ new generation smartphones, mobile applications and the Internet to deliver the major components of CR at home. To validate the CAP model for its capacity to improve CR participation rates and demonstrate health benefits similar to that of traditional centre-based programs (TCR), this thesis undertook a randomised controlled trial (RCT). The results of the RCT demonstrated CAP CR to deliver health outcomes similar to that of TCR and to significantly improve uptake, adherence and completion rates. Furthermore, using Process Evaluation methods to explore the potential of implementing CAP CR in clinical practice, results showed that it is an accessible and acceptable option for delivering CR for individuals that are not willing or able to attend TCR. Diabetes self-management has been identified as an essential element of diabetes management. Suboptimal management of T2DM increases the risk of costly and debilitating diabetes-related complications. The Australian Telephone-Linked Care (TLC) Diabetes program is an automated interactive and conversational intervention which uses voice recognition to engage and support individuals living with T2DM to better self-manage their condition. An earlier study reported that participants receiving the TLC Diabetes program showed a significant decrease in glycaemic control measured with HbA1c and also a significant improvement in the mental component of a health-related quality of life. This thesis, through Process Evaluation of the intervention, explored the feasibility of implementing such a program in real world conditions. The TLC Diabetes program demonstrated very high reach with individuals at risk of diabetes complications with a good level of implementation fidelity, program adoption and positive user perceptions. TLC Diabetes shows potential to provide an effective, convenient, easily accessible, and scalable approach for improving T2DM self-management. In conclusion, this thesis explored the delivery of two different technology-based strategies to provide resources and supports for improving self-management of patients living with CVD (CAP CR) and T2DM (TLC Diabetes). Both programs have shown the potential for expanding health service delivery, from traditionally delivered face to face encounters, to the patient’s home and community. If properly developed, implemented and evaluated, ICT platforms such as these have excellent potential to support and improve the self-management of chronic disease. Exploiting the different mechanisms and/or components of delivery offered by CAP and TLC Diabetes, could lead to improvement in self-management also for other chronic conditions

Mobile applications towards prevention and management of chronic diseases

Chronic disease is the leading cause of death and disability, and poses a major burden to heathcare systems in Australia and other western countries. To alleviate this burden, we developed three mobile phone based solutions to address primary and secondary prevention of the leading chronic diseases such as cardiovascular diseases and chronic obstructive pulmonary diseases. This paper focuses on how the mobile solutions could address the clinical problems, and briefly discusses some of the preliminary findings

Developing a user centred smartphone application for patients with acute coronary syndrome: The MoTER-ACS intervention

Background:Post-discharge interventions are limited for patients with Acute Coronary Syndromes (ACS) due to few scheduled visits to outpatient clinics and traveling from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions.Objective:The aim of this study was to develop a smartphone-based intervention to provide post-discharge support for patients with ACS.Methods:In 2017, a series of small studies (pre-study survey) were conducted in the Prince Charles hospital, Queensland, Australia which consisted of questionnaires with a convenience sample of ACS patients (N=30), a focus group discussion with healthcare professionals (N=10) and an online survey with cardiologists (N=15). The results of the patients’ survey identified the educational topics of the MoTER-ACS intervention. The focus group with healthcare professionals assisted with identifying educational materials, health monitoring and self-management interventions. Monitoring symptoms related to heart failure exacerbation considered as weekly diary based on the results of the online survey with cardiologists.Results:The smartphone application covers multimedia educational materials to adopt a healthy lifestyle and, user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain assisting patients to self-manage their condition. Using the web-portal, clinicians can regularly access to patients’ data and provide support.Conclusions:The feasibility of the MoTER-ACS intervention as a home-based program is tested in a pilot study. If proven valid, this research, would enable clinicians to overcome accessibility barriers of home-based rehabilitation with the clinical expertise, supervision, and coaching that has traditionally been limited to hospital-based services

Use of mobile phone based health applications in home care delivery of cardiac rehabilitation

Cardiovascular disease is the leading cause of death and one of the greatest burdens to economies worldwide. Cardiac rehabilitation can effectively address risk factors prevalent to cardiovascular disease, as well as reduce morbidity and mortality. In spite of documented benefits, poor rates of referral, uptake and utilization of cardiac rehabilitation programs continue. The Care Assessment Platform (CAP) is an innovative home care model which provides an alternative delivery approach to rehabilitation for cardiac patients, utilising a mobile phone platform. This paper reports results on use and user acceptance of mobile phone applications utilised in the CAP model and evaluated in a randomized controlled trial. The implementation of mobile applications in the CAP model showed high usage and acceptance by patients (>85%). Mobile applications, such as a health diary and step counter, show promise in supporting self monitoring and management of lifestyle related health risk factors in the management of other chronic diseases

Mobile health applications in cardiac care

Rapid advances in mobile health technologies and their ubiquitous communication capacity have invigorated remote healthcare delivery. Mobile health applications can help counter the mounting pressure on cardiac services. Patients are increasingly using health and well-being applications, including those for chronic disease monitoring. Population-screening applications are becoming widely used and can have a significant impact on early detection in future. Studies show that cardiology services are using mobile technologies to provide earlier diagnosis through remote transmission and interpretation of ECG, leading to more accurate triage and shorter door-to-balloon time in myocardial infarction. Arrhythmias can be monitored in real time, supported by automated detection algorithms, and implantable device status checks can efficiently and safely be carried out remotely. Ongoing monitoring for and early detection of deterioration in heart failure can also be achieved through mobile applications. Cardiac rehabilitation has been delivered remotely utilizing mobile technologies. Mobile health offers significant potential in providing effective, efficient and appropriately personalized care; however, further studies are required to confirm this. The objective of this review is to explore and describe studies of mobile health applications in cardiac care, including the implications for interventional cardiology, with a focus on clinical outcomes

A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study

BackgroundCardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. ObjectiveThis paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. MethodsThe theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. ResultsThe target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. ConclusionsWe developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing