Remote Cardiac Rehabilitation With Wearable Devices

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study

PURPOSE@#Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients' homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR).@*METHODS@#All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients' homes to hospital on their participation in our OCR program.@*RESULTS@#Patients whose road distance from home to hospital was 0-10 km, 10-20 km, and 20-30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80-4.96; OR 2.98, 95% CI 2.61-3.40; and OR 1.90, 95% CI 1.61-2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001).@*CONCLUSIONS@#Using geographical analysis, we successfully evaluated the factors influencing patients' participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies.@*TRIAL REGISTRATION@#UMIN000028435.

Assessment of training in cardiac auscultation using a simulator / 医学教育

The use of simulators for skills training has become widespread. However, no quantitative analysis has been performed to determine whether simulation-based medical education is useful for improving the acquisition of clinical skills. The educational effect must be evaluated to further develop stimulation-based education. A seminar for cardiac auscultation was held, with the skills laboratory taking the initiative; the effectiveness was verified, and various problems were identified.1)The skills laboratory held a series of training seminars to examine the effectiveness of simulation-based education.2) Sixteen medical students participated in the seminars. One seminar lasted 120 minutes, including 60 minutes of lectures and 60 minutes of skills training. All students attended the three seminars. A questionnaire survey, a written examination, and a skills test were administered to all students three times (before, immediately after, and 5 months after the seminars).3) The students were extremely satisfied with the seminars. The students believed their cardiac auscultation skills had improved and that this improvement was still present 5 months later. After the seminars, the heart sound simulators were used more frequently than before the seminar.4) The results of skills testing after the seminars were better than those before the seminars and remained better 5 months later. However, results of a written examination 5 months after the seminars were similar to those before the seminars.5) The seminars in the skills laboratory were effective for improving students' auscultation skills and increased the effective use of mannequins in the skills laboratory.

Initial clinical cases of the use of a NF-kappaB decoy at the site of coronary stenting for the prevention of restenosis.

BACKGROUND: Nuclear factor-kappaB (NF-kappaB) plays a pivotal role in restenosis after percutaneous coronary intervention (PCI) and the aim of the present clinical trials was to evaluate the effectiveness of a NF-kappaB decoy for preventing restenosis. METHODS AND RESULTS: The initial case was a patient suffering from effort angina who had stenoses in the proximal and middle portions of the right coronary artery. The patient received 2 stents; the NF-kappaB decoy was delivered to the distal site, but not the proximal site. Six months after the PCI, the NF-kappaB decoy had suppressed restenosis in comparison with the no-decoy transfection site. The second case was a patient who underwent single-stent insertion and decoy transfection at the same site, and minimal intimal thickening was observed at 6 month after PCI. No systemic adverse effects were observed in either case. CONCLUSIONS: These results indicate the clinical usefulness and safety of NF-kappaB decoy transfection after PCI, but further evaluations are necessary to confirm its clinical effectiveness.

Practice in Medical Interviewing During Clinical Clerkship / 医学教育

Practice in medical interviewing was held for 5th-and 6th-year medical students during their clinical clerkships. The purpose of the program was to acquire interviewing skills, to communicate with patients by considering the patient's point of view, and to obtain proper medical information. Communication skills and patients' medical problems were discussed after the interview. Students had difficulty obtaining appropriate medical information considering the patients' point of view. They professed an interest in communication skills and relationships between patients and doctors, but their concern after interview practice apparently shifted to collecting medical information and to their lack of knowledge essential for diagnosis. Students were satisfied with this training program and believed it was useful. Practice in medical interviewing in the last years of medical school is effective for teaching communication skills and for obtaining appropriate medical information.

Practice of the Medical Interview in which Medical Students Participated as Standardized Patients / 医学教育

First and 2nd-year medical students participated as standardized patients in practice for the medical interview. This practice was effective both for students playing doctors for learning medical communication skill and for students playing as a patients for allowing them to understand the patient's situation.