Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use.
The link between neuropsychological impairments and chronic tobacco smoking is not clear and in the current literature there is a lack of robust analyses investigating this association. A systematic review of the literature was conducted in order to identify relevant longitudinal and cross-sectional studies conducted from 1946 to 2017. A meta-analysis was performed from 24 studies testing the performance of chronic tobacco smokers compared with non-smokers on neuropsychological tests related to eight different neuropsychological domains. The results revealed a cross-sectional association between neuropsychological impairments and chronic tobacco smoking in cognitive impulsivity, non-planning impulsivity, attention, intelligence, short term memory, long term memory, and cognitive flexibility, with the largest effect size being related to cognitive impulsivity (SDM=0.881, p <0.005), and the smallest effect size being related to intelligence (SDM=0.164, p<0.05) according to Cohen's benchmark criteria. No association was found between chronic smoking and motor impulsivity (SDM=0.105, p=0.248). Future research is needed to investigate further this association by focusing on better methodologies and alternative methods for nicotine administration.
Ehlers-Danlos Syndrome (EDS) are a heterogeneous group of genetic connective tissue disorders, and typically manifests as weak joints that subluxate/dislocate, stretchy and/or fragile skin, organ/systems dysfunction, and significant widespread pain. Historically, this syndrome has been poorly understood and often overlooked. As a result, people living with EDS had difficulty obtaining an accurate diagnosis and appropriate treatment, leading to untold personal suffering as well as ineffective health care utilization. The GoodHope EDS clinic addresses systemic gaps in the diagnosis and treatment of EDS. This paper describes a leap forward—from lack of awareness, diagnosis, and treatment—to expert care that is tailored to meet the specific needs of patients with EDS. The GoodHope EDS clinic consists of experts from various medical specialties who work together to provide comprehensive care that addresses the multi-systemic nature of the syndrome. In addition, EDS-specific self-management programs have been developed that draw on exercise science, rehabilitation, and health psychology to improve physical and psychosocial wellbeing and overall quality of life. Embedded into the program are research initiatives to shed light on the clinical presentation, underlying mechanisms of pathophysiology, and syndrome management. We also lead regular educational activities for community health care providers to increase awareness and competence in the interprofessional management of EDS beyond our doors and throughout the province and country.
Background Apheresis treatments require adequate venous access using peripheral intravenous (PIV) catheterization or central venous catheters (CVC). Ultrasound‐guided PIV (USGPIV) can be used to decrease the need of CVC insertions for apheresis procedures. Method A hybrid model of USGPIV and standard of care (SOC) for PIV access was developed. Nurses performed USGPIV on all patients considered for PIV access if felt SOC PIV access was not possible. Information was collected regarding nurses’ confidence with access, number of attempts required, site of access, complications, and need for CVC. Results In all, 226 PIV access attempts were made during a 2‐month period. All apheresis procedure types were represented. A total 65% were accessed by SOC and 35% by USGPIV. USGPIV was successful on first try on 90% draw/inlet access and 87% successful on first try on return access. Access above the antecubital fossa was required in 31% of USGPIV for draw/inlet veins, and 22% of return veins. Nurses’ confidence with accessing PIV was increased by USGPIV, based on 7‐point Likert scale assessments. During the recording period, 2/226 (0.9%) apheresis procedures required a CVC. In a separate cohort of only hematopoietic progenitor cell collections, CVC insertion was required in 44/238 (18.5%) patients, in 7 months prior to adoption of USGPIV and 5/152 (3.3%) patients in 7 months following adoption of USGPIV. Conclusion A hybrid model of using SOC and USGPIV for PIV access for apheresis procedures resulted in decreased need for CVC access, high levels of successful initial access attempts, and increased nursing confidence in PIV access.
Introduction: The Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorders (G-HSD) comprise a heterogeneous group of genetic disorders of abnormal synthesis and/or maturation of collagen and other matricellular proteins. EDS is commonly characterized by manifestations such as multi joint hypermobility that can lead to musculoskeletal pains, subluxations and dislocations, fragile skin, organ dysfunction, and chronic significant diffuse pain with fatigue, deconditioning eventuating to poor quality of life. Evidence suggests exercise and rehabilitation interventions may ameliorate symptoms of unstable joints, recurrent subluxations/dislocations, and chronic widespread musculoskeletal pain. To date, there have only been a few reports describing exercise and rehabilitation care strategies for people with EDS.Methods: In this manuscript, we describe the GoodHope Exercise and Rehabilitation (GEAR) program, its overarching principles, as well as the program development and delivery model. The GEAR program aims to decrease functional impairment, reduce pain, increase confidence in symptom self-management, and provide a community of support for people with EDS/G-HSD. To achieve these goals, we detail the model of care that includes exercise and rehabilitation therapy, education for self-management, and support accessing relevant community resources.Strengths and Limitations of the Study: GEAR represents a novel exercise and rehabilitation care model for people with G-HSD and various clinical EDS subtypes, beyond the commonly included hEDS subtype. Systematic collection of data via validated measurements is ongoing and will guide the refinement of GEAR and support the development of emerging exercise and rehabilitation programs for people with EDS.
Despite evidence from trials and meta-analysis that cardiac rehabilitation 'works', only 15-30% of eligible patients participate. 1 This causes many to lament: why don't more patients get referred to and use cardiac rehabilitation programs?Using telehealth to deliver cardiac rehabilitation has been proposed as an innovative way of improving patient uptake, choice and access. 2,3 The systematic review of telehealth cardiac rehabilitation programs by Huang et al. 2 ostensibly provides more justification for the utilization of telehealth cardiac rehabilitation. However, the review actually draws attention to significant limitations about the credibility of current evidence supporting telehealth cardiac rehabilitation. We suggest that the included trials use of out-dated technology, short follow-up points and trial heterogeneity make it difficult to draw conclusions regarding the effectiveness of telehealth versus center-based cardiac rehabilitation programs.Only two of the nine included trials utilized the internet or email and no trials examined text messaging interventions. Telephone support was used in seven of the trials reviewed. Remarkably, none of the trials included dated from after 2007 -the year the iPhone was first introduced. It is difficult to make credible comparisons with the modern day from such dated trials in an area subject to rapid technological change and advances.In regard to follow-up, four of the included trials did not collect follow-up data beyond 12 weeks -only two included trials collected data beyond 12 months. While the goal of cardiac rehabilitation is to support patients to recover from their cardiac event, an equally important goal is to prevent future cardiac events. Studies with such short-term follow-up periods are unlikely to detect the long-term effects of cardiac rehabilitation -which meta-analysis indicates are likely to accrue only after two to five years. 4 The heterogeneity in this review is high; there is evidence of substantial clinical heterogeneity (e.g. different study populations and phases of rehabilitation) and methodological heterogeneity (e.g. different technologies used and exercise patterns). Haung et al. 2 could have better managed these variations and the statistical heterogeneity they contribute to by using a random effects statistical model to pool all of the study data (random effects model was used for total cholesterol data only). The random effects model, unlike the fixed effects model, does not assume that these diverse interventions have a single shared and identical underlying effect size despite their many differences. 5 As these models can produce different results, this reliance on the more naı¨ve fixed effects model is problematic.Is telehealth cardiac rehabilitation a compelling alternative to center-based cardiac rehabilitation? We suggest that strengthening our evidence should be urgently prioritized. Instead of reiterating the message that 'telehealth cardiac rehabilitation interventions works' and/or is comparable to center-based cardiac reha...
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