Aims and objectives. To explore patients’ perspectives on the significance of informal carers in their information management.
Background. Being well informed is considered a prerequisite for the ...ability of heart failure patients to manage their lives at home. Developing knowledge about the informal caregiver’s role in patient information management is important, that is, accurate information adapted to the individual level of comprehension.
Design. A qualitative approach using in‐depth semi‐structured interviews conducted with patients was used.
Methods. Eight women and six men suffering from heart failure and with a mean age of 79·6 were interviewed. Data were collected one week after their discharge. A content analysis was performed.
Results. The informal carer’s role in information management from the patient’s perspective represents two different phenomena. The first, information ambivalence, is related to the background of the informal carer. From what patients experienced, the process of information involvement throughout their hospital stay was affected by whether or not their informal carer had a health care background. The second phenomenon, information ambivalence, is related to the relationship between the patient and the informal carer with regard to information management at home.
Conclusion. The informal carers were of great importance in the information management process because the patients relied on them so as to be able to devote their energy to managing their daily life.
Relevance to clinical practice. Patients should be assessed with regard to their information management problems and to the role of their informal carers in this process.
At termination of obstructive apneas, arousal is a protective mechanism that facilitates restoration of upper airway patency and airflow. Treating obstructive sleep apnea (OSA) by continuous positive ...airway pressure (CPAP) reduces arousal frequency indicating that such arousals are caused by OSA. In heart failure (HF) patients with central sleep apnea (CSA), however, arousals frequently occur several breaths after apnea termination, and there is uncertainty as to whether arousals from sleep are a consequence of CSA. If so, they should diminish in frequency when CSA is attenuated. We therefore sought to determine whether attenuation of CSA by CPAP reduces arousal frequency.
Randomized controlled clinical trial.
We examined data from 205 HF patients with CSA (apnea-hypopnea index AHI > or =15, > 50% were central) randomized to CPAP or control who had polysomnograms performed at baseline and 3 months later.
In the control group, there was no change in AHI or frequency of arousals. In the CPAP-treated group, the AHI decreased significantly (from mean +/- SD 38.9 +/- 15.0 to 17.6 +/- 16.3, P < 0.001) but neither the frequency of arousals nor sleep structure changed significantly.
These data suggest that attenuation of CSA by CPAP does not reduce arousal frequency in HF patients. We conclude that arousals were not mainly a consequence of CSA, and may not have been acting as a defense mechanism to terminate apneas in the same way they do in OSA.
Patients with heart failure (HF) live with a serious disease, and need long‐term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the ...European Society of Cardiology and focuses on self‐care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi‐experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form‐36. One hundred sixty‐two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.
Cheyne-Stokes respirations occur in 40% of patients with heart failure. Orthopnea is a cardinal symptom of heart failure and may affect the patient's sleeping angle. The objective of this study was ...to assess the respiratory and hemodynamic response to sleeping angle in a group of subjects with stable heart failure.
Twenty-five patients underwent overnight polysomnography with simultaneous and continuous impedance cardiographic monitoring. Sleeping polysomnographic and impedance cardiographic data were recorded.
The study was conducted in a sleep center.
All 25 patients had clinically stable heart failure and left ventricular ejection fractions < 40%.
The patients slept at 0 degrees, 15 degrees, 30 degrees, and 45 degrees in random order.
Seventeen patients had Cheyne-Stokes apneas (index > 5/h) and 23 patients had hypopneas (index > 5/h). The hypopnea index showed no response to sleeping angle. The Cheyne-Stokes apnea index decreased with increasing sleeping angle (P < 0.001). This effect was seen only during supine sleep and non-rapid eye movement sleep and was absent in non-supine sleep, rapid eye movement sleep, and during periods of wakefulness. Thoracic fluid content index and left ventricular hemodynamics measured by impedance cardiography showed no response to sleeping angle.
Changing the heart failure patient's sleeping angle from 0 degrees to 45 degrees results in a significant decrease in Cheyne-Stokes apneas. This decrease occurs on a constant base of hypopneas. The changes in Cheyne-Stokes apneas are not related to changes in lung congestion and left ventricular hemodynamics.
This research aims to investigate the impact of a physical rehabilitation program on the functioning of the left and right ventricles, as well as to evaluate the quality of life among individuals ...diagnosed with heart failure. The main objective is to assess the efficacy of a multidisciplinary method to physical rehabilitation for patients with cardiac failure. A total of 100 patients diagnosed with heart failure were randomly assigned to two groups: a treatment group consisting of 50 patients and a control group consisting of 50 patients. The intervention group underwent a 12-week physical rehabilitation program consisting of supervised exercise training, lifestyle modification education, and psychological support. The standard medical care was provided to the control group. Left and right ventricular function as well as psychological well-being were evaluated using echocardiography and quality of life surveys. The participants who underwent the intervention showed significant improvements in the functioning of both the left and right ventricles, unlike the control group. Moreover, there was a substantial enhancement in the intervention group's overall quality of life. The physical rehabilitation program, encompassing physical exercises, guidance on lifestyle adjustments, and psychological assistance, has demonstrated its efficacy in enhancing the function of both the left and right ventricles, as well as improving the overall quality of life for individuals suffering from heart failure. These research findings strongly support the advantages of adopting a multidisciplinary strategy in physical rehabilitation for patients with heart failure. The results suggest that a physical rehabilitation program consisting of exercise training, education on lifestyle modification, and psychological support should be included in standard care for heart failure patients.
In order to correctly manage heart failure and prevent the exacerbation of their condition, patients need to monitor their own health and pay attention to things such as weight gain, aggravated ...shortness of breath or a lack of physical activity. However, for various reasons, many patients
are uncertain about the necessary methods for managing their own health, which often leads to repeated hospitalisations. To address the problems associated with heart failure patients being readmitted to hospital over and over again, Dr Yoko Hattori, a researcher formerly based at Konan Women's
University and now at Otemae University in Japan, has developed an evaluation scale for self-monitoring by patients with heart failure (ESSMHF). Hattori worked as a nurse and met many heart failure patients who were stuck in a loop of being admitted to hospital, discharged, then readmitted.
Over time, she came to believe that something had to be done to aid patients in those circumstances and decided upon a self-monitoring system. 'Self-monitoring is a useful concept for breaking through the vicious cycle of repeatedly being in and out of hospital. One of the aims of nursing
for chronic heart failure patients is to enhance the self-care behaviour of patients,' explains Hattori. 'While self-care is a large-scale concept, the details of self-monitoring are part of the processes affecting self-care behaviour and, since the appropriateness of patients' self-monitoring
directly affects self-care behaviour, self-monitoring is considered to be key for the improvement of self-care behaviour.'
The research team posits that cardiac rehabilitation can greatly improve the prognosis of heart failure patients and also prevent cognitive decline, but the rate in Japan is low as Yamaoka-Tojo ...highlights: 'The participation rate of cardiac rehabilitation during the recovery phase in
Japan is significantly lower than in Europe and the US, and great expectation is gathered from the viewpoint of improving prognosis of patients with CVD, suppression of medical expenses, and prevention of long-term care.' She and her team hope the situation can be improved through research
and education. Yamaoka-Tojo and her team are exploring the association between CVD and cognitive impairment. They are seeking to decipher whether cardiac rehabilitation for chronic heart failure patients can prevent the progression of cognitive dysfunction. This is an area of research that
has previously been overlooked, as Yamaoka-Tojo explains: 'The main reason for this is that only in Japan are there so many elderly people over 100-years-old. The super-ageing society is accelerating at a tremendous speed and enough research has not been done until now.' Important discoveries
The researchers believe that vascular endothelial dysfunction is caused by a disorder of the vascular endothelial glycocalyx (EC-GLX) layer. They have made a number of discoveries to date, namely that comprehensive cardiac rehabilitation improves the vascular endothelial function and cognitive
function of elderly chronic heart failure patients. 'Comprehensive cardiac rehabilitation aimed at patient education on disease management and increased physical activity is useful for suppressing the increase of elderly heart failure patients with multi-disease prevalent cognitive decline,'
Yamaoka-Tojo explains. The researchers are now conducting a longitudinal cross-sectional study that involves the risk assessment of CVD and cognitive function targeting an EC-GLX embrittled area, comprehensive rehabilitation using this index on the prevention of cardiovascular disease progression
and usefulness in improving cognitive function. Looking ahead, they intend to use the EC-GLX evaluation clarified by their research to identify the effects of CVD management and cardiac rehabilitation. Ultimately, they hope to ensure good health in the ageing population in Japan and beyond.
Heart failure is a serious disease which increases mortality as well as hospital admission rates for affected patients. Disease management programs supported by telehealth solutions are ...cost-effective approaches for reducing all-cause mortality and heart failure hospitalizations. A 6-minute walk test (6MWT) app could help heart failure patients to self-monitor their functional capacity. We have developed such an application capable of tracking the geolocation, guiding users through a 6MWT and providing the walked distance after six minutes. Besides common global navigation satellite system (GNSS) filtering methods like a Kalman filter, we have investigated the impact of positioning the device (tablet) and GNSS reception on the accuracy of the test. In a field experiment, we gathered 166 6MWT recordings with the developed mobile application. Applying the Kalman filter reduced the overall relative error from 35.5 % to 3.7 %. Wearing the tablet on the body led to significantly better results than holding it in the hand (p < .001). The average accuracy of 2.2 % of body-worn measurements was below previously defined thresholds for reliable results. It thus allows to define a procedure on how to perform and integrate an accurate 6MWT in telehealth settings for clinical decision support in heart failure patients.
ABSTRACT
Rationale: This article reports on commissioned research funded by the Swedish Council of Technology Assessment in Health Care (SBU) and the Swedish Nursing Society (SSF). The objective was ...to review computer‐based education programs. However, as the review produced insufficient evidence of effectiveness, the publication was withheld due to a previous incident where such evidence was misunderstood by Swedish policy and health care decision makers.
Aims: This article highlights the concept of evidence with regard to the consequences of insufficient evidence of effectiveness being mistaken for evidence of no effectiveness. The aim is also to present a systematic review evaluating a computer‐based education program for patients suffering from severe mental illness.
Methods: Systematic database searches in Medline, CINAHL, PsycINFO and the Cochrane Library identified a total of 131 potentially relevant references. Thereafter, 27 references were retrieved as full‐text documents, of which 5 were finally included and co‐reviewed by two independent researchers.
Findings: The review found no decisive evidence of effectiveness regarding computer‐based education programs designed to assist persons suffering from severe mental illness.
Implications for Practice and Policy: Failing to see the difference between insufficient evidence and evidence of no effectiveness may have unexpected consequences. As a result, practice may be misguided and treatments withheld, which at worse may have harmful consequences for patients. In the end, it is of utmost importance that researchers do good quality research by ensuring statistical power and quality of outcome measurement. For example, this review of computer‐based education programs could have revealed effective ways of dealing with severe mental illness if the studies included had been conducted using more sophisticated designs.
In this paper we describe an ICT solution which allows patients not skilled with web technology to access a web service for clinical surveillance and advanced processing of biomedical signals. Today ...this is important because of increase in the number of patients suffering from chronic diseases, who need more than other home-monitoring and usually are not skilled with web technology. The solution uses an Interactive Voice Response (IVR) in order to provide the elderly with an audio user interface for access complex service via web.
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