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1.
Stroke ; 51(5): 1419-1427, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32279620

RESUMO

Background and Purpose- Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemic stroke. Methods- We identified clinical practice guidelines/consensus statements through searches of 4 electronic databases and hand-searching of websites/reference lists. Two reviewers independently assessed reports for eligibility. We extracted data on report characteristics and recommendations relating to etiologic workup in acute ischemic stroke and in cases of cryptogenic stroke. Quality was assessed using the AGREE II tool (Appraisal of Guidelines for Research & Evaluation). Recommendations were synthesized according to a published algorithm for diagnostic evaluation in cryptogenic stroke. Results- We retrieved 16 clinical practice guidelines and 7 consensus statements addressing acute stroke management (n=12), atrial fibrillation (n=5), imaging (n=5), and secondary prevention (n=1). Five reports were of overall high quality. For all patients, guidelines recommended routine brain imaging, noninvasive vascular imaging, a 12-lead ECG, and routine blood tests/laboratory investigations. Additionally, ECG monitoring (>24 hours) was recommended for patients with suspected embolic stroke and echocardiography for patients with suspected cardiac source. Three reports recommended investigations for rarer causes of stroke. None of the reports provided guidance on the extent of investigation needed before classifying a stroke as cryptogenic. Conclusions- While consensus exists surrounding standard etiologic workup, there is little agreement on more advanced investigations for rarer causes of acute ischemic stroke. This gap in guidance, and in the underpinning evidence, demonstrates missed opportunities to better understand and protect against ongoing stroke risk. Registration- URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019127822.

2.
Syst Rev ; 8(1): 331, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847884

RESUMO

BACKGROUND: Stroke is a leading cause of death and disability worldwide. Identifying the aetiology of ischaemic stroke is essential in order to initiate appropriate and timely secondary prevention measures to reduce the risk of recurrence. For the majority of ischaemic strokes, the aetiology can be readily identified, but in at least 30% of cases, the exact aetiology cannot be determined using existing investigative protocols. Such strokes are classed as 'cryptogenic' or as a stroke of unknown origin. However, there exists substantial variation in clinical practice when investigating cases of seemingly cryptogenic stroke, often reflecting local service availability and the preferences of treating clinicians. This variation in practice is compounded by the lack of international consensus as to the optimum level and timing of investigations required following a stroke. To address this gap, we aim to systematically review and compare recommendations in evidence-based clinical practice guidelines (CPGs) that relate to the assessment and investigation of the aetiology of ischaemic stroke, and any subsequent diagnosis of cryptogenic stroke. METHOD: We will search for CPGs using electronic databases (MEDLINE, Health Management Information Consortium (HMIC), EMBASE, and CINAHL), relevant websites and search engines (e.g. guideline specific websites, governmental, charitable, and professional practice organisations) and hand-searching of bibliographies and reference lists. Two reviewers will independently screen titles, abstracts and CPGs using a pre-defined relevance criteria form. From each included CPG, we will extract definitions and terms for cryptogenic stroke; recommendations related to assessment and investigation of the aetiology of stroke, including the grade of recommendations and underpinning evidence. The quality of the included CPGs will be assessed using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. Recommendations across the CPGs will be summarised descriptively highlighting areas of convergence and divergence between CPGs. DISCUSSION: To our knowledge, this will be the first review to systematically compare recommendations of international CPGs on investigating the aetiology of ischaemic stroke. The findings will allow for a better understanding of international perspectives on the optimum level of investigations required following a stroke and thus contribute to achieving greater international consensus on best practice in this important and complex area. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019127822.

3.
Br J Gen Pract ; 69(687): e689-e696, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31455643

RESUMO

BACKGROUND: Financial incentives in the UK such as the Quality and Outcomes Framework (QOF) reward GP surgeries for achievement of nationally defined targets. These have shown mixed results, with weak evidence for some measures, but also possible unintended negative effects. AIM: To look at the effects of a local intervention for atrial fibrillation (AF) and hypertension, with surgeries rewarded financially for work, including appointing designated practice leads, attendance at peer review workshops, and producing their own protocols. DESIGN AND SETTING: A controlled before-after study comparing surgery performance measures in UK primary care. METHOD: This study used published QOF data to analyse changes from baseline in mean scores per surgery relating to AF and hypertension prevalence and management at T1 (12 months) and T2 (24 months) for the intervention group, which consisted of all 58 surgeries in East Lancashire Clinical Commissioning Group (CCG), compared to the control group, which consisted of all other surgeries in north-west England. RESULTS: There was a small acceleration between T0 (baseline) and T2 in recorded prevalence of hypertension in the intervention group compared to the controls, difference 0.29% (95% confidence interval [CI] = 0.05 to 0.53), P = 0.017, but AF prevalence did not increase more in the intervention group. Improvement in quality of management of AF was significantly better in the intervention group, difference 3.24% (95% CI = 1.37 to 5.12), P = 0.001. CONCLUSION: This intervention improved diagnosis rates of hypertension but not AF, though it did improve quality of AF management. It indicates that funded time to develop quality-improvement measures targeted at a local population and involving peer support can engage staff and have the potential to improve quality.

4.
J Appl Res Intellect Disabil ; 32(5): 1067-1077, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30983088

RESUMO

BACKGROUND: Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population. METHODS: Semi-structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. A study topic guide was developed to elicit practitioners' views and experiences of barriers and facilitators to weight management for adults with intellectual disabilities. Responses were analysed using thematic analysis. RESULTS: Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities. CONCLUSIONS: This study provides suggestions for future research, policy and practice consideration.


Assuntos
Atitude do Pessoal de Saúde , Acesso aos Serviços de Saúde , Deficiência Intelectual , Pessoas com Deficiência Mental , Obesidade/terapia , Programas de Redução de Peso , Adulto , Comorbidade , Humanos , Deficiência Intelectual/epidemiologia , Obesidade/epidemiologia , Pesquisa Qualitativa
5.
BMJ Open ; 8(6): e021911, 2018 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-29921688

RESUMO

OBJECTIVE: Mental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects. DESIGN: A systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers. PARTICIPANTS: Study samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities. INTERVENTIONS: Eligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design. OUTCOMES: Symptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems. RESULTS: We retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data. CONCLUSIONS: Mental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities. PROSPERO REGISTRATION NUMBER: CRD 42015024469.


Assuntos
Deficiência Intelectual/psicologia , Transtornos Mentais/terapia , Adulto , Criança , Humanos , Saúde Mental , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
J Appl Res Intellect Disabil ; 31 Suppl 1: 39-51, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28631874

RESUMO

BACKGROUND: Obesity is more prevalent in people with intellectual disabilities and increases the risk of developing serious medical conditions. UK guidance recommends multicomponent weight management interventions (MCIs), tailored for different population groups. METHODS: An integrative review utilizing systematic review methodology was conducted to identify the types of MCIs delivered to adults with intellectual disabilities. FINDINGS: Five studies were identified. All of the studies' MCIs were tailored for adults with intellectual disabilities. Tailoring included measures such as simplified communication tools, individualized sessions, and the presence of carers where appropriate. CONCLUSIONS: Emerging evidence suggests ways in which MCIs can be tailored for adults with intellectual disabilities but, given the few studies identified, it is not possible to recommend how they can be routinely tailored. Further studies are justified for adults with intellectual disabilities at risk of obesity-related conditions.


Assuntos
Comorbidade , Deficiência Intelectual , Obesidade/terapia , Programas de Redução de Peso/métodos , Adulto , Humanos , Deficiência Intelectual/epidemiologia , Obesidade/epidemiologia
7.
Br J Gen Pract ; 65(632): e141-51, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25733435

RESUMO

BACKGROUND: Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. AIM: To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. DESIGN AND SETTING: A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. METHOD: Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. RESULTS: A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. CONCLUSION: While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.


Assuntos
Acesso à Informação , Sistemas de Informação em Atendimento Ambulatorial/organização & administração , Assistência à Saúde/organização & administração , Registros Eletrônicos de Saúde/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde , Comunicação , Humanos , Atenção Primária à Saúde/organização & administração
8.
BMJ Open ; 4(9): e006021, 2014 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-25200561

RESUMO

OBJECTIVES: To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. SETTING: Primary care. PARTICIPANTS: A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. RESULTS: No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. CONCLUSIONS: Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091.


Assuntos
Acesso à Informação , Registros Eletrônicos de Saúde , Pacientes , Coleta de Dados , Assistência à Saúde , Registros Eletrônicos de Saúde/organização & administração , Humanos , Pacientes/psicologia , Qualidade da Assistência à Saúde
9.
Indian J Public Health ; 58(2): 113-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24820985

RESUMO

It was a qualitative enquiry conducted amongst Gujjar population of Shimla district, Himachal Pradesh (HP). The study was carried out to link various lifestyle factors of the Gujjar population with the 2002 outbreak of plague in HP. Focus Group discussions guide was prepared beforehand which had information about education, livelihood, dietary pattern, relationships, personal hygiene and habits and health care utilization. It was emerged out of the study that the population has poor literacy levels, poor personal hygiene, overcrowding in hutments, closely-knit social structure, lack of awareness about common diseases, and frequent visits to forests and living in caves during their visits. Further, government health care facilities are not routinely utilized by the Gujjar community. These factors might lead to increased proximity and exposure to wild rats among Gujjar population, thus increasing their susceptibility to plague. They are, therefore a potential link between any source of infection in forests and in native population of HP and other states. The government agencies should take various measures to increase health care access of such vulnerable population through outreach health care programs.


Assuntos
Surtos de Doenças , Estilo de Vida , Peste/epidemiologia , Animais , Conscientização , Cavernas , Aglomeração , Escolaridade , Feminino , Grupos Focais , Humanos , Higiene , Índia/epidemiologia , Masculino , Ratos , Fatores de Risco , Árvores
10.
BMC Public Health ; 14: 325, 2014 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-24708892

RESUMO

BACKGROUND: This qualitative investigation was conducted to determine the socio-epidemiological factors related to the plague outbreak (2002) in Himachal Pradesh (HP), India. METHODS: The data for socio-epidemiological factors related to the plague outbreak (2002) in HP was obtained from residents through 150 in-depth Interviews (IDI) and 30 Focus Group Discussions (FGD) during six visits (from May 2011 to April 2012) by the research team. Natives, health officials and the nomadic population were interviewed. According to their opinion and viewpoints data was collected and their lifestyle and hunting practices were studied in detail. Tape recorders were used during various FGDs and IDIs. The interviews and FGDs were later transcribed and coded. In-depth analysis of the recorded data was done using an inductive thematic analysis approach. RESULTS: The study reports that the outbreak in 2002 in a few villages of Himachal Pradesh was that of plague and it occurred by the contact of an index case with wild animals after hunting and de-skinning. The first wave of plague transmission which took 16 lives of residents was followed by a second wave of transmission in a ward of a tertiary care hospital where one visitor acquired it from relatives of the index case and succumbed. The life-style practices of residents (hunting behavior, long stay in caves and jungles, overcrowding in houses, poor hygiene and sanitation, belief in 'God' and faith healers for cure of diseases) was optimal for the occurrence and rapid spread of such a communicable disease. The man-rodent contact is intensified due to the practice of hunting in such a rodent-ridden environment. The residents harbor a strong belief that plague occurs due to the wrath of gods. Various un-reported outbreaks of plague were also observed by officials, residents and old folk. The persistence of plague in HP is favoured by its hilly terrain, inaccessible areas, inclement weather (snow) in winters, unhygienic lifestyle, hunting practices of residents, and treatment practices through faith healers. CONCLUSIONS: This study suggests that the lifestyle of the natives of HP and other socio-epidemiological factors played a role in the outbreak of plague in that area.


Assuntos
Surtos de Doenças , Peste/epidemiologia , Animais , Grupos Focais , Humanos , Índia/epidemiologia , Entrevistas como Assunto , Estilo de Vida , Masculino , Peste/etiologia , Peste/transmissão , Pesquisa Qualitativa , Roedores/microbiologia , Saneamento
11.
Lancet Psychiatry ; 1(7): 522-30, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26361311

RESUMO

BACKGROUND: People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID. METHODS: We did a longitudinal cohort study that used data from The Health Improvement Network primary care database. We did multivariate logistic regression to assess associations between various characteristics and whether or not practices had opted in to the incentivised scheme. FINDINGS: We assessed data for 8692 patients from 222 incentivised practices and those for 918 patients in 48 non-incentivised practices. More blood tests (eg, total cholesterol, odds ratio [OR] 1·88, 95% CI 1·47-2·41, p<0·0001) general health measurements (eg, smoking status, 6·0, 4·10-8·79, p<0·0001), specific health assessments (eg, hearing, 24·0, 11·5-49·9, p<0·0001), and medication reviews (2·23, 1·68-2·97, p<0·0001) were done in incentivised than in non-incentivised practices, and more health action plans (6·15, 1·41-26·9, p=0·0156) and secondary care referrals (1·47, 1·05-2·05, p=0·0256) were made. Identification rates were higher in incentivised practices for thyroid disorder (OR 2·72, 95% CI 1·09-6·81, p=0·0323), gastrointestinal disorders (1·94, 1·03-3·65, p=0·0390), and obesity (2·49, 1·76-3·53, p<0·0001). INTERPRETATION: Targeted annual health checks for people with ID in primary care could reduce health inequities. FUNDING: National Institute for Health Research.

13.
Inform Prim Care ; 20(4): 271-82, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23890339

RESUMO

BACKGROUND: Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR). International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care. OBJECTIVE: To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care. METHOD: Two reviewers independently searched 11 international databases during the period 1999-2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion. A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis. Prospero (International Prospective Register of Systematic Reviews) registration number: crd42012003091.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Internet , Acesso dos Pacientes aos Registros , Segurança do Paciente , Qualidade da Assistência à Saúde/organização & administração , Assistência Ambulatorial/organização & administração , Humanos , Capacitação em Serviço , Cooperação do Paciente , Revisões Sistemáticas como Assunto
15.
Br J Gen Pract ; 60(576): 295-304, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20594431

RESUMO

BACKGROUND: While practice-level or team accreditation is not new to primary care in the UK and there are organisational indicators in the Quality and Outcomes Framework (QOF) organisational domain, there is no universal system of accreditation of the quality of organisational aspects of care in the UK. AIM: To describe the development, content and piloting of version 1 of the Primary Medical Care Provider Accreditation (PMCPA) scheme, which includes 112 separate criteria across six domains: health inequalities and health promotion; provider management; premises, records, equipment, and medicines management; provider teams; learning organisation; and patient experience/involvement, and to present the results from the pilot service evaluation focusing on the achievement of the 30 core criteria and feedback from practice staff. DESIGN OF STUDY: Observational service evaluation using evidence uploaded onto an extranet system in support of 30 core summative pilot PMCPA accreditation criteria. SETTING: Thirty-six nationally representative practices across England, between June and December 2008. STUDY POPULATION: interviews with GPs, practice managers, nurses and other relevant staff from the participating practices were conducted, audiotaped, transcribed, and analysed using a thematic approach. For each practice, the number of core criteria that had received either a 'good' or 'satisfactory' rating from a RCGP-trained assessment team, was counted and expressed as a percentage. RESULTS: Thirty-two practices completed the scheme, with nine practices passing 100% of core criteria (range: 27-100%). There were no statistical differences in achievement between practices of different sizes and in different localities. Practice feedback highlighted seven key issues: (1) overall view of PMCPA; (2) the role of accreditation; (3) different motivations for taking part; (4) practice managers dominated the workload associated with implementing the scheme; (5) facilitators for implementation; (6) patient benefit--relevance of PMCPA to quality improvement; (7) recommendations for improving the scheme. CONCLUSION: Version 1 of PMCPA has been piloted as a primary care accreditation scheme and shown to be relevant to different types of practice. The scheme is undergoing revision in accordance with the findings from the pilot and ongoing consultation.


Assuntos
Acreditação , Competência Clínica/normas , Medicina de Família e Comunidade/normas , Atenção Primária à Saúde/normas , Inglaterra , Retroalimentação , Humanos , Motivação , Projetos Piloto , Carga de Trabalho
16.
Eur J Cardiovasc Nurs ; 9(4): 272-7, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20418166

RESUMO

INTRODUCTION: In the United Kingdom (UK) ethnic minority groups from the Indian sub-continent (India, Pakistan and Bangladesh) are at increased risk of coronary heart disease (CHD) related mortality and morbidity. The aim of this study was to assess the variation in recording of clinical data by ethnicity following the implementation of an electronic centralised cardiac rehabilitation register in the North West of England. METHODS: Data were collected over 18 months for all individuals (n=1993) assessed for entry into the cardiac rehabilitation programme. Analysis of the recording of clinical data was undertaken by ethnicity with adjustment for gender, age group and deprivation. RESULTS: Most patients on the database had their ethnicity recorded (94.4%). South Asians (Indian, Pakistani and Bangladeshi) were less likely to have clinical data items recorded compared to the majority White British group. The disparity in recording of clinical data was most marked for the Hospital Anxiety and Depression Scale score (adjusted OR 0.16, 95% CI 0.07-0.36), body mass index (adjusted OR 0.54, 95% CI 0.37-0.79), pulse (0.60, 95% CI 0.42-0.88), blood glucose (adjusted OR 0.64, 95% CI 0.44-0.93) and cholesterol (adjusted OR 0.64, 965% CI 0.44-0.95). CONCLUSION: Recording of clinical data relevant to successful cardiac rehabilitation was poorer among South Asian patients.


Assuntos
Cardiopatias/etnologia , Cardiopatias/reabilitação , Melhoria de Qualidade/organização & administração , Sistema de Registros , Reabilitação/normas , Idoso , Bangladesh/etnologia , Inglaterra , Feminino , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Paquistão/etnologia , Melhoria de Qualidade/estatística & dados numéricos , Sistema de Registros/normas , Fatores de Risco
17.
Eur J Cardiovasc Nurs ; 9(1): 68-74, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19932059

RESUMO

BACKGROUND: In the United Kingdom ethnic minority groups from the Indian sub-continent (India, Pakistan and Bangladesh) are at increased risk of coronary heart disease related mortality and morbidity. Variation in prevalence and outcome is in part related to access to appropriate health care. AIMS: This study explores the experiences of participants following an acute cardiac event; with a specific focus on reasons for the take up of cardiac rehabilitation services. METHODS: Twenty participants (12 Pakistani, 6 Indian and 2 Bangladeshi) eligible for CR were interviewed using a semi-structured format. RESULTS: Previous negative experience of the health care service related to communication difficulties was an important factor for not engaging with cardiac rehabilitation services. The importance of interventions by professional friends and family members appeared to increase appropriate access to care. Gender and religious beliefs were also important aspects that had an impact on uptake of services. Reasons for non-attendance were also related to service provision (setting and timing of classes), practical considerations (language barrier and transport problems), and poor understanding of cardiac rehabilitation. CONCLUSIONS: The findings highlight significant barriers to uptake at the participant level which require changes at the system and provider level if uptake is to improve.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Cardiopatias , Grupos Minoritários/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Enfermagem em Reabilitação/estatística & dados numéricos , Adulto , Idoso , Bangladesh/etnologia , Barreiras de Comunicação , Inglaterra/epidemiologia , Feminino , Cardiopatias/etnologia , Cardiopatias/enfermagem , Cardiopatias/reabilitação , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Paquistão/etnologia , Prevalência , Fatores de Risco , Apoio Social
18.
Br Med Bull ; 81-82: 65-79, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17339273

RESUMO

Since the publication of the National Service Framework for coronary heart disease, there has been a move towards primary disease prevention with a greater focus on an individual's absolute risk. Meta-analysis and systematic reviews of the evidence for primary prevention are incomplete and the current guidelines and policy have led to considerable confusion in clinical practice. There is an increased use of risk assessment tools but no effective method of reviewing current activity with the limited integration into the existing Quality Outcome Framework. There is an inadequate evidence for some of the risk factors used to identify individuals at risk, the risk calculators used to quantify the degree of risk and the methods of communicating risk to patients are largely unproven or completely missing. There is a need for a co-ordinated vascular disease prevention programme which can be applied at the individual and at the population level but is also amenable to evaluation.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Serviços Preventivos de Saúde/métodos , Atenção Primária à Saúde , Doenças Cardiovasculares/epidemiologia , Doença das Coronárias/epidemiologia , Doença das Coronárias/prevenção & controle , Humanos , Indicadores de Qualidade em Assistência à Saúde , Medição de Risco , Fatores de Risco , Reino Unido/epidemiologia
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