Patients’ and providers’ perspectives and needs of telemonitoring to support clinical management and self-care of people at high-risk for preeclampsia (Preprint)

2021 ◽  
Author(s):  
Maria Aquino ◽  
Janessa Griffith ◽  
Tessy Vattaparambil ◽  
Sarah Munce ◽  
Michelle Hladunewich ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Thematic Analysis ◽  
Clinical Management ◽  
Healthcare Providers ◽  
Self Care ◽  
Self Management ◽  
Close Monitoring ◽  
Structured Interviews ◽  
Increased Risk

BACKGROUND Preeclampsia is one of the leading causes of maternal mortality in the world with the global prevalence at 2% to 8% of pregnancies. Patients at high-risk for preeclampsia (PHRPE) have an increased risk of complications such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for a timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. OBJECTIVE The objective of this study was to determine the perceptions and needs of PHRPE and their healthcare providers with respect to telemonitoring through semi-structured interviews with both groups. This study explored: 1) What are the needs and challenges of monitoring PHRPE during pregnancy and in the postpartum period? 2) What are the features required in a telemonitoring program to support self-care and clinical management of PHRPE? METHODS This study used a qualitative descriptive approach and thematic analysis was conducted. PHRPE and healthcare providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada were asked to participate in individual semi-structured interviews. Two researchers jointly developed a coding framework and coded each interview separately to ensure that the interviews were double coded. The software program NVivo version 12 was used to help organize the codes. RESULTS Seven PHRPE and five healthcare providers, which included a nurse practitioner and physicians, participated in the semi-structured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure measurements and appropriate interventions for abnormal blood pressure readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers of telemonitoring for PHRPE included financial and personal barriers as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision-making for clinicians, as well as the inclusion of evidence-based action prompts. CONCLUSIONS The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study included the specific features of a telemonitoring program for PHRPE, as well as use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE.

scholarly journals Using wearables and self-management apps in patients with COPD: a qualitative study

2019 ◽  
Vol 5 (3) ◽  
pp. 00036-2019 ◽  
Author(s):  
Robert C. Wu ◽  
Shiphra Ginsburg ◽  
Tatiana Son ◽  
Andrea S. Gershon
Keyword(s):  
Qualitative Study ◽  
Thematic Analysis ◽  
Mobile Application ◽  
Continuous Monitoring ◽  
Healthcare Providers ◽  
Self Management ◽  
Chronic Obstructive ◽  
Structured Interviews ◽  
Daily Lives ◽  
Obstructive Pulmonary Disease

BackgroundTechnology such as wearable technology and self-management applications could improve the care of patients with chronic obstructive pulmonary disease (COPD) by real-time continuous monitoring, early detection of COPD and improved self-management. However, patients have not been willing to use technology when it is too difficult to use, interferes with their daily lives or threatens their identity, independence and self-care.MethodsWe conducted a qualitative study to determine what patients with COPD would like to see in a wearable device and a mobile application to help manage their condition. Semi-structured interviews were conducted, recorded and transcribed. Thematic analysis was used to identify themes and concepts.ResultsWe interviewed 14 people with COPD with an average age of 69 years. Participants perceived that the technology could improve their ability to manage their condition both in daily life and during exacerbations by connecting how they feel and by knowing their oxygen saturation, heart rate and activity. The technology may help them address feelings of fear and panic associated with exacerbations and may provide reassurance and connectedness. Some people with COPD wanted their healthcare providers to have access to their data, while others were concerned about inundating them with too much information. Of note, people wanted to maintain control of the information; to make connections with the data, but also in order to be alerted when a possible exacerbation occurs.ConclusionPatients perceived significant potential for wearables and apps to help manage their condition.

scholarly journals Exploring the potential for introducing home monitoring of blood pressure during pregnancy into maternity care: current views and experiences of staff—a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e037874
Author(s):  
Lisa Hinton ◽  
James Hodgkinson ◽  
Katherine L Tucker ◽  
Linda Rozmovits ◽  
Lucy Chappell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Maternity Care ◽  
Healthcare Providers ◽  
Home Monitoring ◽  
Structured Interviews ◽  
Group Discussions ◽  
Self Monitoring ◽  
Team Members ◽  
Registration Number ◽  
In Pregnancy

ObjectiveOne in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomised data from contemporary trials to guide the efficacy of self-monitoring of BP (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial.DesignExploratory study using a qualitative approach.SettingEight hospitals, English National Health Service.ParticipantsObstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147).MethodsSemi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.ResultsThe main themes to emerge around SMBP include (1) different BP changes in pregnancy, (2) reliability and accuracy of BP monitoring, (3) anticipated impact of SMBP on women, (4) anticipated impact of SMBP on the antenatal care system, (5) caution, uncertainty and evidence, (6) concerns over action/inaction and patient safety.ConclusionsThe potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women’s health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations and the relationships between and responsibilities of healthcare providers and women.Trial registration numberNCT03334149.

scholarly journals Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing

2017 ◽  
Vol 9 (2) ◽  
pp. 145 ◽  
Author(s):  
Katharine Wallis ◽  
Rebecca Tuckey
Keyword(s):  
General Practice ◽  
High Risk ◽  
The Elderly ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Medicines Information ◽  
Care For The Elderly ◽  
Increased Risk ◽  
Information Brochure ◽  
Practice Methods

ABSTRACT INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.

Comparison of hypertensive outcomes after the implementation of self-management program for older adults with uncontrolled hypertension in Krabi, Thailand: a quasi-experimental study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Saowaluck Sukpattanasrikul ◽  
Supreeda Monkong ◽  
Sirirat Leelacharas ◽  
Orapitchaya Krairit ◽  
Chukiat Viwatwongkasem
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Older Adults ◽  
Self Care ◽  
Self Management ◽  
Uncontrolled Hypertension ◽  
Control Group ◽  
Content Type ◽  
Care Behavior

PurposeThis study aims to examine the effects of a self-management program (SMP) on self-care behavior, blood pressure and quality of life among older adults with uncontrolled hypertension.Design/methodology/approachA quasi-experimental design with repeated measures was conducted in two primary care units in Krabi, Thailand. One hundred and fifty-six older adults with uncontrolled hypertension were selected based on the inclusion criteria and divided into experimental and control groups with 78 participants in each. The experimental group received the SMP, including the intervention related to the self-management process (from the 1st to 4th weeks) and a follow-up phase (from the 5th to 16th weeks). The control group received standard care. The outcomes were measured over time, including self-care behavior (baseline, 4th and 16th weeks), blood pressure (baseline, 4th, 8th, 12th and 16th weeks) and quality of life (baseline and 16th week).FindingsThe generalized estimating equations showed that the SMP, compared with the control group, statistically significantly improved self-care behavior (p < 0.001), decreased blood pressure (p < 0.001) and improved quality of life (p < 0.001) at the 16th week.Originality/valueThe SMP improved the self-care behavior, decreased blood pressure and improved the quality of life among older adults with uncontrolled hypertension. Registered nurses could administer this program for long-term benefits and help reduce the burden on primary care services.

Primary Cardioprotection Reduces Mortality in Lymphoma Patients with Increased Risk of Anthracycline Cardiotoxicity, Treated by R-CHOP Regimen

Chemotherapy ◽  
2018 ◽  
Vol 63 (4) ◽  
pp. 238-245 ◽  
Author(s):  
Monika Długosz-Danecka ◽  
Alicja M. Gruszka ◽  
Sebastian Szmit ◽  
Agnieszka Olszanecka ◽  
Tomasz Ogórka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Overall Survival ◽  
High Risk ◽  
Cardiovascular Mortality ◽  
Control Group ◽  
Close Monitoring ◽  
Historical Cohort ◽  
Anthracycline Cardiotoxicity ◽  
Clinical Issue ◽  
Increased Risk

Background: Advances in anti-lymphoma therapy prolong overall survival, making late adverse effects, like doxorubicin-related cardiotoxicity, an even more important clinical issue. The effectiveness of cardioprotective strategies with close monitoring, angiotensin-converting enzyme inhibitors and/or β-blockers as well as liposomal doxorubicin are still unconfirmed in clinical practice. Methods: This study evaluated the role of a primary cardioprotection strategy in preventing cardiovascular mortality and heart failure occurrence in non-Hodgkin lymphoma (NHL) patients with a high risk of anthracycline cardiotoxicity. Thirty-five NHL patients were subjected prospectively to ramipril and/or bisoprolol at NHL diagnosis, before implementing doxorubicin-containing regimens. Additionally, patients with a diagnosis of asymptomatic/mild heart failure received the liposomal form of doxorubicin. The clinical outcome and frequency of all serious cardiac events were compared with the results in a historical cohort of 62 high-risk cases treated without primary cardioprotection. Results: NHL patients with a primary cardioprotection strategy did not experience cardiovascular deaths in contrast to the retrospective control group where cardiovascular mortality was 14.5% at 3 years (p < 0.05). Primary cardioprotection also decreased the frequency of new cardiotoxicity-related clinical symptoms (2.8 vs. 24.1%; p < 0.05) and prevented the occurrence of cardiac systolic dysfunction (0 vs. 8.5%, respectively; p < 0.05). Although the study was not planned to detect any survival benefit, it demonstrated a trend towards increased response rates (complete response 82 vs. 67%; p not significant) and prolonged survival (projected 5-year overall survival 74 vs. 60%; p < 0.05) for patients treated with primary cardioprotection. Conclusions: A primary personalized cardioprotection strategy decreases the number of cardiac deaths and may potentially prolong overall survival in NHL patients with increased risk of anthracycline cardiotoxicity.

scholarly journals Characteristics of self-management among patients with complex health needs: a thematic analysis review

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028344 ◽  
Author(s):  
Annie-Pier Gobeil-Lavoie ◽  
Maud-Christine Chouinard ◽  
Alya Danish ◽  
Catherine Hudon
Keyword(s):  
Chronic Diseases ◽  
Thematic Analysis ◽  
Healthcare Providers ◽  
Self Management ◽  
Management Support ◽  
Management Skills ◽  
Healthcare Needs ◽  
Frequent Use ◽  
Dominant Condition ◽  
Use Of Health Services

ObjectiveThere is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs.DesignThematic analysis review of the literature.MethodsWe developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000–October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al.ResultsTwenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills.ConclusionsThis review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.

scholarly journals Association of APOL1 Genotypes With Measures of Microvascular and Endothelial Function, and Blood Pressure in MESA

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Teresa K. Chen ◽  
Ronit Katz ◽  
Michelle M. Estrella ◽  
Wendy S. Post ◽  
Holly Kramer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Kidney Disease ◽  
Endothelial Function ◽  
Aortic Distensibility ◽  
The United States ◽  
Flow Mediated Dilation ◽  
Arterial Elasticity ◽  
Increased Risk ◽  
Significant Difference

Background APOL1 high‐risk genotypes are associated with increased risk for hypertension‐attributed kidney disease among Black adults in the United States. Biopsy studies show differences in kidney vasculature by APOL1 status; less is known about the variants' associations with systemic vascular and endothelial function. Whether APOL1 risk variants are associated with blood pressure (BP) is also uncertain. Methods and Results Using linear regression, we examined cross‐sectional associations of APOL1 risk genotypes (high=2 risk alleles, low=0 or 1 risk allele) with subclinical measures of vascular function (small arterial elasticity, n=1586; large arterial elasticity, n=1586; ascending aortic distensibility, n=985) and endothelial function (flow‐mediated dilation, n=777). Using linear mixed‐effects models, we studied longitudinal associations of APOL1 risk genotypes with BP (n=1619), adjusting for age, sex, and African ancestry. Among 1619 (12% APOL1 high‐risk) Black participants in MESA (Multi‐Ethnic Study of Atherosclerosis), mean age was 62 years old, 58% had hypertension, and mean systolic BP was 131 mm Hg at baseline. At examination 1 (2000–2002), there was no significant difference in small arterial elasticity, large arterial elasticity, ascending aortic distensibility, or flow‐mediated dilation in participants with APOL1 high‐ versus low‐risk genotypes ( P >0.05 for all). Over a mean follow‐up of 7.8 years, relative annual changes in systolic and diastolic BP and pulse pressure did not differ significantly by APOL1 risk status (between‐group differences of −0.20, −0.14, and −0.25, respectively; P >0.05 for all). Conclusions Among Black participants in MESA, APOL1 high‐risk genotypes were not associated with subclinical vascular and endothelial function or BP trajectories. The relationship of APOL1 with kidney disease may be intrinsic to the kidney rather than through peripheral effects on systemic vasculature or BP.

scholarly journals Perceptions of Strategies and Intervention Approaches for HIV Self-Management among Ugandan Adolescents: A Qualitative Study

2019 ◽  
Vol 18 ◽  
pp. 232595821882324 ◽  
Author(s):  
Massy Mutumba ◽  
Henry Mugerwa ◽  
Victor Musiime ◽  
Anudeeta Gautam ◽  
Hellen Nakyambadde ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Self Care ◽  
Hiv Care ◽  
Self Management ◽  
Care Needs ◽  
Behavioral Skills ◽  
Social Challenges ◽  
Management Intervention ◽  
Care Outcomes ◽  
Living With Hiv

The heightened vulnerability of adolescents to poor HIV care outcomes underscores the need for interventions that create and promote HIV self-management behavioral skills. Adolescents living with HIV (ALHIV) experience a complex array of physical, emotional, and social challenges that constrain their self-care, but the majority of existing psychosocial programs focus primarily on medication adherence. Understanding adolescents’ self-care needs, challenges, and preferences is necessary for developing effective culturally relevant interventions. The involvement of caregivers and stakeholders is also critical to realizing positive self-care outcomes. This article presents the findings from focus group discussions with ALHIV, caregivers, and healthcare providers on self-care. The data were collected as part of formative research in the development of a self-management intervention for Ugandan ALHIV. Participants’ discussions on self-care strategies and intervention approaches provide valuable insights to guide the development of interventions to promote positive HIV care outcomes among Ugandan ALHIV.

PALB2 mutations in Brazilian patients from North-Northeast regions.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13670-e13670
Author(s):  
Thamara Ferreira ◽  
Thais Ferreira Bomfim-Palma ◽  
Isabelle Joyce de Lima Silva-Fernandes ◽  
Gabriela Espirito Santo Felix ◽  
Inacelli Queiroz De Souza Caires ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Male Breast Cancer ◽  
Clinical Management ◽  
Susceptibility Gene ◽  
High Risk Patient ◽  
Male Breast ◽  
The North ◽  
Number Of Patients ◽  
Increased Risk

e13670 Background: Loss-of-function mutations in PALB2 gene are associated with increased risk for breast cancer and possibly pancreatic, ovarian, male breast, prostate, colorectal as others cancers. In Brazil it has been estimated that up to 1,516 new cases of hereditary breast cancer for 2020 in the North and Northeast regions. Analysis of susceptibility gene mutations helps identify precisely the high-risk patient and their families, whom need specific and personalized clinical management as high-risk individuals. Methods: Twenty-six patients with pathogenic mutations in PALB2 gene identify by next-generation sequencing from states of Bahia (11), Ceará (9), Pernambuco (5) and Rondônia (1) in the North and Northeast regions were analyzed. Results: Most of the patients analyzed had only breast cancer (80%), including two cases of male breast cancer (9,5%); the others were isolated cases of endometrial cancer (4%), breast and pancreas cancers (4%), breast and lung cancers (4%), only ovarian cancer (4%) and ovarian and breast cancers (4%). Most cancers were stage II or III (65%). Family history of cancer was observed in 22/26 (84%); the most common tumors were breast, prostate, pancreas and thyroid. The founder mutations were more frequent in exons: 4 (58%) and 12 (15%). Eleven variants were found as follow: c.1240C > T (19%); c.3256delC (15%); c.1671_1674delTATT (11.5%); c.355delC (11.5%); NC_000016.9:g.(?_23632673)_(23652488_?)del (11,5%). The greatest variety of mutations was found in the state of Bahia, probably due to the greater number of patients included (42%). Conclusions: These data suggest that changes in clinical management of PALB2 patients are needed since the phenotype observed exhibited pattern of hereditary tumors, including male breast cancer. Besides that, PALB2 gene should be included in painel gene analysis in patients from the North and Northeast of Brazil because its high frequency of pathogenic variants.

scholarly journals Patients’ and providers’ perspectives and needs of telemonitoring to support clinical management and self-care of people at high-risk for preeclampsia (Preprint)

10.2196/32545 ◽  
2021 ◽  
Author(s):  
Maria Aquino ◽  
Janessa Griffith ◽  
Tessy Vattaparambil ◽  
Sarah Munce ◽  
Michelle Hladunewich ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Management ◽  
Self Care
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