Effect of an interactive, educational app about venous thromboembolism and anticoagulation on patient satisfaction: A randomized controlled trial.

BACKGROUND: Adequate patient education is essential for patients to engage in shared decision-making when deciding to stop or continue anticoagulation after 3 months for venous thromboembolism (VTE). Our objectives were to evaluate the effect of an interactive, educational app on patients' level of satisfaction with information, perceived level of knowledge, decisional conflict and extent of shared decision-making when deciding on treatment duration of VTE. MATERIALS AND METHODS: This randomized controlled trial in 1 academic and 3 general Dutch hospitals included adult patients diagnosed with VTE without malignancy or prolonged anticoagulation for other indications. Patients were randomized in 1:1 ratio to receive the app (intervention group) in addition to hospital-specific standard of care. The app, created for this study, contains information on VTE and anticoagulation on an interactive timeline. In the week preceding the consultation when treatment duration is decided, patients were provided with daily videos using push notifications. Outcomes were assessed through self-reported questionnaires at baseline, 1-2 days before and 1 day after consultation. Data were analyzed using t-tests and linear mixed models for repeated measurements. RESULTS: Data of 56 patients were analyzed (mean age 57 ± 13; 27% female). On a numeric rating scale from 0 to 10, patients who received the app were 0.9 points (95%CI 0.0-1.7; p 0.04) more satisfied with the provided information. Patients who received the app experienced significantly less decisional conflict. No differences in other outcomes were observed. CONCLUSIONS: An educational app about VTE and anticoagulation increases patients' satisfaction and reduces decisional conflict when deciding on treatment duration of VTE. This study was registered in the Netherlands Trial Register (NL7037).

[Health effects of fish oil and fish oil supplements: consumption advice sustained]. / Gezondheidseffecten van visolie en visoliepreparaten: gebruiksadvies gehandhaafd.

Omega-3 fatty acids are thought to have beneficial effects on atherosclerosis. Recently, the results ofa systematic review on the health effects of omega-3 fatty acids were published. The risk of cardiovascular death in subjects randomised to taking omega-3 fats was not significantly decreased: relative risk = 0.87 (95% CI: 0.73-1.03). In a 2004 Cochrane review, the same authors concluded that there was a significant beneficial effect on total mortality, combined cardiovascular endpoints and cancer. Inclusion of the recent 'Diet and reinfarction trial' (DART-2-trial) had a decisive negative effect on the results of the recent meta-analysis. Excluding this study resulted in a relative risk of cardiovascular death of 0.83 (95% CI: 0.75-0.91). Since the DART-2 study had methodological shortcomings, it still appears that recommending sufficient intake of omega-3 fatty acids is justifiable, preferably by eating fish but ifnecessary by using fish oil supplements, especially for patients at high risk of cardiovascular disease.

Carotid intima-media thickness at different sites: relation to incident myocardial infarction; The Rotterdam Study.

AIMS: We examined whether intima-media thickness of the common carotid artery, carotid bifurcation, internal carotid artery and the combined measure are predictive of future myocardial infarction and which of the measurements has the strongest predictive value. METHODS AND RESULTS: We used a case-cohort approach in the Rotterdam Study. Ultrasound images of the common carotid artery, carotid bifurcation and the internal carotid artery were made. We selected the first 194 myocardial infarctions in the total population (mean follow-up 4.6 years). Analyses were done using Cox regression with adjustment for age and sex. The risk ratios (RR) for myocardial infarction associated with mean maximum common carotid, bifurcation, internal carotid intima-media thickness and the combined measurements were 3.18 (95% confidence interval, 1.83-5.54), 4.11 (2.10-8.05), 5.31 (1.77-15.9) and 6.27 (3.27-12.0), respectively, for the highest compared to the lowest quartile. The RRs for myocardial infarction per standard deviation increase of common carotid, bifurcation, internal carotid artery and combined intima-media thickness were 1.44 (1.28-1.62), 1.34 (1.17-1.53), 1.12 (0.94-1.33) and 1.47 (1.31-1.65), respectively. The areas under the ROC curves for the three measurements and the combined measure were not significantly different. CONCLUSIONS: Increased carotid intima-media thickness is a strong predictor of future myocardial infarction and all measurement sites have the same ability to predict future myocardial infarction.