Limited availability of cardiac rehabilitation for heart failure patients in the United Kingdom: findings from a national survey

Background: Participation of patients with heart failure in cardiac rehabilitation in the UK is low. This study investigated the availability of cardiac rehabilitation services for patients with heart failure in the UK and the views of service coordinators on ideal service models. Design: Our study was a cross-sectional national postal survey that was mailed to 342 service coordinators in the UK between April and June 2009. Methods: We developed a 38-item questionnaire to survey all cardiac rehabilitation service coordinators on theNational Audit of Cardiac Rehabilitation register in the UK in 2009. Results: The survey response rate was 71% (244/342). Forty three per cent (105/244) of coordinators did not accept patients with heart failure to their cardiac rehabilitation services. Most coordinators who did accept patients with heart failure offered their services to patients with a variety of cardiac conditions, though referral criteria and models of care varied widely. Services inconsistently used New York Heart Association classes and left ventricular ejection fraction measures to select patients. Few offered separate dedicated heart failure programmes (14%; 33/244) but where these existed they ran for longer than programmes which included patients with heart failure alongside other cardiac patients (10.9 vs 8.5 weeks; F=4.04; p=0.019). Few offered home-based options for patients with heart failure (11%; 27/244). Coordinators accepting patients with heart failure to their cardiac rehabilitation services tended to agree that patients with heart failure should be included in services alongside other cardiac patients (X2=6.2; p=0.013). Conclusions: There is limited access for patients with heart failure to cardiac rehabilitation in the UK. Local policies on referral and selection criteria differ and reflect coordinators views rather than clinical guidance. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav

Profile of Ohio Adults with Low Environmental Literacy

Author Institution: Food, Agricultural and Biological Engineering, The Ohio State University ; Strategic Research Group ; School of Health Sciences, Ohio UniversityEnvironmental literacy is defined as an understanding of natural systems combined with how they interact with human social systems. An Ohio study measured adults' knowledge of ecological principles as the basis of understanding. A telephone survey of 504 Ohio adults measured their knowledge of ecological principles along with their demographics. Low literacy adults are significantly different from those who exhibit high literacy. The lowest literacy group was characterized as less educated, below the median household income, older, female, and minority. Low literacy adults are less likely to engage in outdoor activities, gain information from environmental groups, but are more likely to gain information from television. Low literacy adults are more likely than high literacy adults to use alternative transportation. In targeting environmental education programs to heads of households and Ohio voters, adults with low environmental literacy need to be approached differently than those with high literacy

Environmental Literacy of Ohio Adults

Author Institution: Food, Agricultural and Biological Engineering, The Ohio State University ; Strategic Research Group ; School of Health Sciences, Ohio UniversityEnvironmental literacy is defined as an understanding of natural systems combined with how they interact with human social systems. Past surveys have measured the pollution knowledge of adults. This study instead examined Ohio adult's knowledge of ecological principles as the basis of understanding. A telephone survey of 504 Ohio adults measured their knowledge of ecological principles. As a group, Ohio adults appear to understand four principles of ecology: biogeography, the earth as a biosphere, ecological energetics, and carrying capacity. Some additional attention should be paid to teaching Ohio adults about three principles of ecology: ecosystem succession, biotic interactions, and the importance of diversity. Most importantly, Ohio adults must learn more about the principle of materials cycling. Ohio adults showed poor understanding of the nitrogen, phosphorus, and hydrologic cycle and bioaccumulation

Parents' experiences of initiation of paediatric advance care planning discussions: A qualitative study

Advance care planning enables parents to discuss their goal and wishes for the future treatment and care of their life-limited or life-threatened child. Whilst research has identified the barriers clinicians face to initiate such discussions, the views of the parents have received scant attention. This qualitative study, using reflexive thematic analysis, aimed to explore parents’ experience of the initiation of their child’s advance care planning discussions, to help provide an understanding to inform future practice. Single interviews were undertaken with 17 non-bereaved and bereaved parents. Parents reported they had engaged with future thinking but needed time before initiating this with clinicians. They identified the need for a trusted professional and time for private, thorough, non-judgemental discussion without feeling clinicians were ‘giving up’. Parents reported that advance care planning discussions were not always aligned to the dynamics of family life. They felt that health professionals were responsible for initiating advance planning conversations according to the families’ individual requirements. There was an apparent lack of standardised protocols to assist paediatric advance care planning discussion initiation. Conclusion: Initiating advance care planning is a complicated process that needs to be tailored to the specific parent and child situation. Health professionals need to appreciate that parents are key contributors to initiate engagement with advance care planning discussions but that they also require support and care, recognising this may facilitate the building of trust, identified as a key corner stone, of paediatric advance care planning initiation and engagement. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00431-021-04314-6

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers.

BACKGROUND: Primary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt-PA) than non-PSCs. The impact of PSCs on racial disparities in rt-PA use is unknown. METHODS AND RESULTS: We used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt-PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt-PA at PSCs than non-PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P CONCLUSIONS: Racial disparities in intravenous rt-PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model

‘Excuse me, I have a delivery’ The [re] construction of interview ‘space' in the Covid-19 pandemic

Covid-19 has transformed the qualitative interview process, as remote video methods have become mainstream, challenging the domination of face-to-face interviews. In the pandemic churn, researchers’ focus was on ensuring participants’safety and care in the virtual interview environment. There was more limited consideration of what this ‘new normal’ meant for the researcher. This reflection draws on two qualitative research projects conducted during the 2020/2021 pandemic period in the UK. We propose that assumptions of ‘space’ in the qualitative interview process have been (re)constructed in remote interviews during Covid19. To be present virtually creates geographic freedoms of participant access, but subjective risks from interviewing in the virtual space. Context can no longer be understood through the shared experience of an interview space. There is a delineation of what is ‘public’ or ‘private’ as participants and researchers share their domestic spheres. Using ethnographic reflections, we explore the changing notions of geographic, public and private space in the Covid-19 interview