An evidence-based analysis of managing hypertension with isometric resistance exercise-are the guidelines current?

Exercise guidelines for managing hypertension maintain aerobic exercise as the cornerstone prescription, but emerging evidence of the antihypertensive effects of isometric resistance training (IRT) may necessitate a policy update. We conducted individual patient data (IPD) meta-analyses of the antihypertensive effects of IRT. We utilized a one-step fitted mixed effects model and a two-step model with each analyzed trial using a random effects analysis. We classified participants as responders if they lowered their systolic blood pressure (SBP) by ≥5 mmHg, diastolic (DBP) or mean arterial blood pressure (MAP) by ≥3 mmHg. Twelve studies provided data on 326 participants. IRT produced significant reductions in SBP, DBP, and MAP. The SBP responder rates for both groups, or the absolute risk reduction (ARR) between groups, was 28.1% in favor of the IRT group. The number needed to treat (NNT) to achieve one 5 mmHg reduction in SBP was 3.56, 95% CI [2.56, 5.83], or four people. The ARR for DBP was 20.0% in favor of IRT. Therefore, the NNT to achieve one 3 mmHg decrease in DBP was five people, 95% CI [3.22, 11.10]. The ARR for MAP was 28.2% in favor of IRT. Therefore, the NNT to achieve one 3 mmHg reduction in MAP was four people, 95% CI [2.80, 7.42]. Our analyses demonstrated that IRT (three times per week for a total of 8 min of squeezing activity) is able to reduce the participants' SBP by 6-7 mmHg, equating to a 13% reduction in the risk for myocardial infarction and 22% for stroke.

The influence of hospital location and 'level of care' on continuing professional development.

Healthcare workers core skills are reinforced and knowledge of latest developments ensured by undertaking systematic continuing professional development. The current study explored the impact of health facility location and level of care provided on the continuing professional development offered to maternity services healthcare workers in Victoria, Australia. An online survey of middle to senior management staff of 71 public and private health services as well as 7 professional bodies was conducted, yielding 114 participants. Analysis was by location (metropolitan or regional/rural) and level of care provided. The findings revealed Australian Health Practitioner Regulation Agency registration is the predominant requirement to provide continuing professional development to staff. Dedicated education departments or educators are significantly underrepresented in Level 1&2 facilities, while Level 5&6 facilities are more likely to provide breastfeeding continuing professional development. Metropolitan locations provided more wide-ranging programmes compared with rural/regional locations. Key enablers are the capacity to share resources, have access to external courses and simulation equipment/centres, and the provision of relevant and timely continuing professional development programmes, indicating that 'Educational hubs' with credentialed staff working from better resourced regional facilities could deliver a complete array of CPD programmes to lower level facilities.

Competencies and skill development in maternity care services in Victoria - A qualitative study.

In healthcare, continuing professional development is provided to ensure professional standards are maintained and for clinicians to remain fit to practice. The purpose of the study was to identify potential gaps or issues with continuing professional development in maternity services through consultations with key stakeholders and, in addition, to generate possible solutions or recommendations towards the development of a state wide continuing professional development program. The data was collected through semi-structured interviews of a purposive sample between June and August 2018. A thematic analysis was undertaken. Participants included a practicing midwife, allied health practitioner (physiotherapist), manager, healthcare educator, and an outlier service worker (maternal and child health nurse). Following the thematic analysis, four main themes (education, practitioner standards, programme monitoring and resources) were identified along with nine sub-themes. The results suggest organisations need to offer explicit support for staff to access to continuing professional development. In addition, the qualifications of facilitators of continuing professional development and/or consumer education are recommended to go beyond education levels required for registration. In this respect, some organisations credentialed their educators locally in a 'train the trainer' manner however, most participants supported professional preparation for the role of educator.

Implementing a thermal care bundle for inadvertent perioperative hypothermia: A cost-effectiveness analysis.

BACKGROUND: Active warming reduces risk of surgical complications. Implementation of a perioperative thermal care bundle increased use of active warming for surgical patients. OBJECTIVE: This study aimed to determine if implementing a thermal care bundle to prevent inadvertent perioperative hypothermia is cost-effective. DESIGN: A model-based cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects. SETTING: Hospitals undertaking between 5,000 and 40,000 surgeries per year, which either implemented or did not implement the thermal care bundle, were modelled. PARTICIPANTS: The decision tree guiding the structure of the model was populated with clinical outcomes (surgical site infection, blood transfusion requirement and morbid cardiac events) of a hypothetical cohort of surgical patients. INTERVENTIONS: Implementation or non-implementation of the thermal care bundle. MAIN OUTCOME MEASURES: Net monetary benefit was calculated by multiplying the health benefits (quality-adjusted life years) by the willingness-to-pay threshold minus the cost. We tested a range of values for willingness to pay per quality-adjusted life year thresholds and plotted results for expected incremental benefits and probability of cost-effectiveness. The incremental cost-effectiveness ratio was also calculated. RESULTS: Thermal care bundle implementation simultaneously reduced costs and increased quality-adjusted life years in the majority of simulations (88.1%). The average cost reduction was $689,659 (95% credible intervals spanned from a $2,718,364 decrease in costs to $379,826 increase in costs) and average difference in quality-adjusted life years was 54 (95% CI = 0.4 less to 176 more). This equated to an incremental cost-effectiveness ratio of $12747 saved per quality-adjusted life year gained. CONCLUSIONS: It is likely that increasing use of active warming by implementing the thermal care bundle would generate cost-savings and improve the quality of life for surgical patients. It would be good value for hospitals with similar characteristics to those included in our model to allocate the extra resources required for implementation.