Effectiveness of the Pharmacist-Involved Multidisciplinary Management of Heart Failure to Improve Hospitalizations and Mortality Rates in 4630 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: There is evidence that heart failure (HF) patients who receive pharmacist care have better clinical outcomes. METHODS AND RESULTS: English-language peer-reviewed randomized controlled trials comparing the pharmacist-involved multidisciplinary intervention with usual care were included. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and the Cochrane Library from inception through March 2017. Cochrane method for risk of bias was used to assess within and between studies. 18 RCTs (n = 4630) were included for systematic review, and 16 (n = 4447) for meta-analysis. Meta-analysis showed a significant reduction in HF hospitalizations {odds ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P = .01, I2  =  39%} but no effect on HF mortality. Similarly, a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P = .02, I2  =  52%] but no effect on all-cause mortality was revealed. The overall trend was an improvement in medication adherence. There were significant improvements in HF knowledge (P<.05), but no significant improvements were found on health care costs and self-care. CONCLUSIONS: The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes. There was a great deal of variability about which specific intervention is most effective in improving clinical outcomes.

Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review.

BACKGROUND: Targeted chronic disease programs are vital to improving health outcomes for Indigenous people globally. In Australia it is not known where evaluated chronic disease programs for Aboriginal and Torres Strait Islander people have been implemented. This scoping review geographically examines where evaluated chronic disease programs for Aboriginal people have been implemented in the Australian primary health care setting. Secondary objectives include scoping programs for evidence of partnerships with Aboriginal organisations, and use of ethical protocols. By doing so, geographical gaps in the literature and variations in ethical approaches to conducting program evaluations are highlighted. METHODS: The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a published protocol. This scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) scoping review methodology. The search included 11 academic databases, clinical trial registries, and the grey literature. RESULTS: The search resulted in 6894 citations, with 241 retrieved from the grey literature and targeted organisation websites. Title, abstract, and full-text screening was conducted by two independent reviewers, with 314 citations undergoing full review. Of these, 74 citations evaluating 50 programs met the inclusion criteria. Of the programs included in the geographical analysis (n = 40), 32.1% were implemented in Major Cities and 29.6% in Very Remote areas of Australia. A smaller proportion of programs were delivered in Inner Regional (12.3%), Outer Regional (18.5%) and Remote areas (7.4%) of Australia. Overall, 90% (n = 45) of the included programs collaborated with an Aboriginal organisation in the implementation and/or evaluation of the program. Variation in the use of ethical guidelines and protocols in the evaluation process was evident. CONCLUSIONS: A greater focus on the evaluation of chronic disease programs for Aboriginal people residing in Inner and Outer Regional areas, and Remote areas of Australia is required. Across all geographical areas further efforts should be made to conduct evaluations in partnership with Aboriginal communities residing in the geographical region of program implementation. The need for more scientifically and ethically rigorous approaches to Aboriginal health program evaluations is evident.

Effectiveness of discharge education strategies versus usual care on clinical outcomes in acute coronary syndrome patients: a systematic review.

OBJECTIVE: The objective of this review was to systematically review studies that evaluated the clinical effectiveness of hospital discharge education strategies provided to patients with acute coronary syndrome (ACS). INTRODUCTION: In an era of shortening lengths of stay for patients with ACS, bedside education opportunities are diminishing; however, the importance of discharge education on medication management, emergency procedures and safe recovery remains vital to prevent rehospitalization. INCLUSION CRITERIA: The following studies were considered for inclusion: English-language randomized controlled trials (RCTs) measuring educational strategies provided to adults with ACS as the only intervention prior to discharge or post-discharge from acute care, compared to usual care. METHODS: An electronic search was performed by an experienced research librarian. MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov and WHO International Clinical Trial Registry Platform were searched for studies published between 2000 and 2017. All citations were collated and uploaded into EndNote where duplicates were removed. Titles and abstracts were screened by two independent reviewers. The reference lists of all included studies were screened for additional references. Risk of bias was assessed using the JBI critical appraisal instrument for all included studies. In the case of missing or incomplete data, corresponding authors were contacted. The primary outcomes of interest were knowledge relating to ACS diagnosis, treatment and procedures. Secondary outcomes included lifestyle modifications, medication adherence/knowledge, general practitioner follow-up, attendance to cardiac rehabilitation (CR), readmission and mortality (up to 12 months). As data were collected using different instruments in each study, meta-analysis was not performed. RESULTS: The electronic search identified 3445 records. Following deduplication, 2093 citations were screened with 47 papers selected for assessment of eligibility. Three RCTs involving 175 participants were identified for inclusion. The certainty of this evidence (Grading of Recommendations, Assessment, Development and Evaluation) was rated as low to moderate. The risk of bias for all included studies was moderate. In all studies, the impact of inpatient educational interventions was assessed in relation to attendance to a CR program, exercise rates and medication adherence. Interventions included targeted educational sessions (15-40 minutes) where participants prioritized their learning needs and were provided tailored cardioprotective risk factor and lifestyle modification advice and invited to attend a CR program. One study presented the education in animation. In one study, intervention groups reported increased attendance to CR compared to control (47.3%; n = 9, versus 21.1%; n = 4) and another demonstrated significantly increased exercise rates from baseline to follow-up. No significant difference was reported between the intervention and control for medication adherence, and none of the studies reported readmission or mortality rates. CONCLUSION: The current review found little to no evidence for the effectiveness of current discharge practices on clinical outcomes. There has been limited research on modes of delivery or what the essential components for ACS discharge education should be. This review has highlighted the need for comprehensive effectiveness studies to provide a strong evidence-base to support ACS discharge practices. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018094781.

Effectiveness of avatar-based technology in patient education for improving chronic disease knowledge and self-care behavior: a systematic review.

OBJECTIVE: The objective of the review was to examine the effectiveness of patient education using avatar-based technology on knowledge and self-care behaviors in patients with chronic disease. INTRODUCTION: Chronic disease is a major global problem. Patients with chronic disease who engage in self-care and self-management of their illnesses have better health outcomes and fewer hospitalizations and complications. Currently, information and communication technologies are used to support self-care and improve health outcomes. Within the body of literature, research into avatar-based technology for patient education is growing rapidly. To date, the evidence has not been systematically reviewed to determine the effectiveness of patient education using avatar-based technology on patients' knowledge and self-care behaviors in chronic disease. INCLUSION CRITERIA: This review included studies of children and adults who have received avatar-based patient education interventions. The comparator was usual care or other forms of educational programs. The outcomes were knowledge, self-care behavior, self-efficacy, health-related quality of life, readmission and medication adherence. Experimental designs were eligible, including non-randomized controlled trials, and quasi-experimental, prospective and retrospective before and after studies. METHODS: Seven databases, including MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, ProQuest, Web of Science, Scopus and three other trial registries, including the World Health Organization (WHO), ClinicalTrials.gov and Australian New Zealand Clinical Trials Registry, were systematically searched for studies published between January 2005 and March 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management Assessment and Review of Information (JBI SUMARI). Data extracted from papers included specific details about the interventions, populations, study methods and outcomes significant to the review question and specific objectives using the standardized data extraction tool from JBI SUMARI. Due to heterogeneity among the included studies, statistical pooling and meta-analysis were not possible. The results were tabulated, and the data narratively synthesized. RESULTS: Nine publications from eight studies were included in this review (n = 752). Three out of the eight studies were randomized controlled trials and five were non-randomized experimental studies. The overall quality of the included studies was moderate. There was a low risk of bias for the randomized controlled trial studies and moderate risk of bias for the quasi-experimental studies. Four of the eight studies showed that patients who participated in avatar-based education had a statistically significant improvement in knowledge (p < 0.05). Three studies showed improvement in behaviors and self-efficacy. Only three of eight studies examined health-related quality of life and adherence to medication, but the results were not statistically significant (p > 0.05). No studies identified the effectiveness of avatar-based patient education on readmission. CONCLUSIONS: Avatar-based technology in patient education can have a positive effect on a wide range of healthcare outcomes. The intervention can improve knowledge, self-care behaviors and self-efficacy in patients with chronic diseases. However, there is limited evidence of improvement in health-related quality of life and adherence to medication, and no available research on readmission.

Electronic textile-based electrocardiogram monitoring in cardiac patients: a scoping review.

OBJECTIVE: The objectives of this scoping review were to explore, organize and present the existing research literature on the use of electronic textile (e-textile)-based resting, signal-averaged, ambulatory or exercise electrocardiogram (ECG) monitoring to evaluate the application of e-textile technologies for ECG cardiac monitoring. INTRODUCTION: E-textile-based ECG monitoring of cardiac patients offers a possible new alternative for in-hospital monitoring and post-discharge monitoring during cardiac rehabilitation. INCLUSION CRITERIA: Studies that included patients (inpatients or outpatients) who qualified for cardiac rehabilitation programs or continuous ambulatory ECG monitoring were considered. The key concepts that were addressed included resting, signal-averaged, ambulatory or exercise ECG monitoring based on e-textile technologies or e-textile-based cardiac rehabilitation. Studies were excluded if they focused only on specific aspects of the e-textile ECG system rather than a complete ECG system. METHODS: Research reports, dissertations or books that evaluated e-textile-based ECG monitoring of cardiac patients in a hospital or at home, written in English, and published between January 2000 and March 2018 were considered for inclusion. Published and unpublished literature was located through databases including Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), Institute of Electrical and Electronics Engineers (IEEE Xplore), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, Web of Science, Scopus, Expanded Academic ASAP, ProQuest Dissertations and Theses Global, SPORTDiscus, and ENGINE-Australian Engineering Database (Informit). Two independent reviewers screened citations for inclusion while the third reviewer resolved any discrepancies. Meta-data from each study were extracted, and a narrative summary was used to present the results. Furthermore, 38 study authors were contacted to request missing or additional data as required, with 16 responding within eight weeks. RESULTS: Of the 207 studies that were eligible for full-text review, only 8% (n = 17) were included in the final study. Eighty-eight percent (n = 15) of included studies were conducted with an adult population, and 11 studies reported an in-hospital application. Only three groups of researchers reported e-textile integration beyond the textile electrodes, mostly in the form of wiring and custom-made printed circuit boards. Eight studies utilized two ECG sensors, while single-lead ECG was the most common configuration, used in 10 studies. ECG result was the primary parameter reported across the included studies. Resting ECG was the most common form of ECG acquired (n = 10), followed by exercise ECG (n = 6) and ambulatory ECG (n = 5). Eight studies addressed the issue of power requirements, and seven studies used Bluetooth for wireless communication. The primary problem reported across all studies was noise from motion artifact. CONCLUSIONS: The recent advances in signal quality and noise reduction for e-textile-based ECG applications are promising. However, the use of a 12-lead, personalized, home-based cardiac rehabilitation monitor system containing fully textile-integrated electronics with diagnostic capability is yet to be reported. Therefore, there is potential for future research in this area. Additionally, motion artifact continues to be a challenge.

Electronic textile electrocardiogram monitoring in cardiac patients: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: This scoping review aims to explore and scope the literature and research on the use of e-textile electrocardiogram (ECG) monitoring in cardiac patients and provide a unique contribution to the available evidence. The objectives of this scoping review are:The questions of this review are.

The Keeping on Track Study: Exploring the Activity Levels and Utilization of Healthcare Services of Acute Coronary Syndrome (ACS) Patients in the First 30-Days after Discharge from Hospital.

The aim of this study was to investigate the impact of bedside discharge education on activity levels and healthcare utilization for patients with acute coronary syndrome (ACS) in the first 30 days post-discharge. Knowledge recall and objective activity and location data were collected by global positioning systems (GPS). Participants were asked to carry the tracking applications (apps) for 30⁻90 days. Eighteen participants were recruited (6 metropolitan 12 rural) 61% ST elevation myocardial infarction (STEMI), mean age 55 years, 83% male. Recall of discharge education included knowledge of diagnosis (recall = 100%), procedures (e.g., angiogram = 40%), and comorbidities (e.g., hypertension = 60%, diabetes = 100%). In the first 30 days post-discharge, median steps per day was 2506 (standard deviation (SD) ± 369) steps (one participant completed 10,000 steps), 62% visited a general practitioner (GP) 16% attended cardiac rehabilitation, 16% visited a cardiologist, 72% a pharmacist, 27% visited the emergency department for cardiac event, and 61% a pathology service (blood tests). Adherence to using the activity tracking apps was 87%. Managing Big Data from the GPS and physical activity tracking apps was a challenge with over 300,000 lines of raw data cleaned to 90,000 data points for analysis. This study was an example of the application of objective data from the real world to help understand post-ACS discharge patient activity. Rates of access to services in the first 30 days continue to be of concern.

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review.

BACKGROUND: Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. METHODS: Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. RESULTS: Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). CONCLUSION: This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied.

Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the primary healthcare setting: a scoping review protocol.

REVIEW QUESTION: The question of this review is: Which locations in Australia have chronic disease programs for Aboriginal and Torres Strait Islander adult populations in the primary healthcare context been evaluated?Specific objectives are to.

Recommendations and practices for the screening of depression and anxiety in acute coronary syndrome: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map current recommendations and practices for the screening of depression and anxiety in acute coronary syndrome patients in the acute care setting.Specifically, the review questions are.

Adherence to activity monitoring devices or smartphone applications for improving physical activity in adults with cardiovascular disease: a systematic review protocol.

REVIEW QUESTION: The question of this review is: what is the adherence to the use of activity monitoring devices or applications to improve physical activity in adults with cardiovascular disease?Specifically, the review objectives are.

Effectiveness of discharge education on outcomes in acute coronary syndrome patients: a systematic review protocol.

REVIEW QUESTION: The question of this review is what is the effectiveness of discharge education on outcomes in acute coronary syndrome patients?