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Nichols EL, Elwyn G, DiScipio A, Sidhu MS, O'Malley AJ, Matlock DD, Alam S, Ross CS, Coylewright M, Malenka DJ, Brown JR. Cardiology providers' recommendations for treatments and use of patient decision aids for multivessel coronary artery disease. BMC Cardiovasc Disord 2021; 21:410. [PMID: 34452596 PMCID: PMC8400903 DOI: 10.1186/s12872-021-02223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Rates of recommending percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) vary across clinicians. Whether clinicians agree on preferred treatment options for multivessel coronary artery disease patients has not been well studied. Methods and results We distributed a survey to 104 clinicians from the Northern New England Cardiovascular Study Group through email and at a regional meeting with 88 (84.6%) responses. The survey described three clinical vignettes of multivessel coronary artery disease patients. For each patient vignette participants selected appropriate treatment options and whether they would use a patient decision aid. The likelihood of choosing PCI only or PCI/CABG over CABG only was modeled using a multinomial regression. Across all vignettes, participants selected CABG only as an appropriate treatment option 24.2% of the time, PCI only 25.4% of the time, and both CABG or PCI as appropriate treatment options 50.4% of the time. Surgeons were less likely to choose PCI over CABG (RR 0.14, 95% CI 0.03, 0.59) or both treatments over CABG only (RR 0.10, 95% CI 0.03, 0.34) relative to cardiologists. Overall, 65% of participants responded they would use a patient decision aid with each vignette. Conclusions There is a lack of consensus on the appropriate treatment options across cardiologists and surgeons for patients with multivessel coronary artery disease. Treatment choice is influenced by both patient characteristics and clinician specialty. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02223-y.
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Affiliation(s)
- Elizabeth L Nichols
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03756, USA.
| | - Glyn Elwyn
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03756, USA
| | | | - Mandeep S Sidhu
- Albany Medical Center, Albany, NY, USA.,Albany Medical College, Albany, NY, USA
| | - A James O'Malley
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03756, USA
| | | | - Shama Alam
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03756, USA
| | - Cathy S Ross
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Jeremiah R Brown
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03756, USA
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Al-Qatatsheh A, Morsi Y, Zavabeti A, Zolfagharian A, Salim N, Z. Kouzani A, Mosadegh B, Gharaie S. Blood Pressure Sensors: Materials, Fabrication Methods, Performance Evaluations and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4484. [PMID: 32796604 PMCID: PMC7474433 DOI: 10.3390/s20164484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022]
Abstract
Advancements in materials science and fabrication techniques have contributed to the significant growing attention to a wide variety of sensors for digital healthcare. While the progress in this area is tremendously impressive, few wearable sensors with the capability of real-time blood pressure monitoring are approved for clinical use. One of the key obstacles in the further development of wearable sensors for medical applications is the lack of comprehensive technical evaluation of sensor materials against the expected clinical performance. Here, we present an extensive review and critical analysis of various materials applied in the design and fabrication of wearable sensors. In our unique transdisciplinary approach, we studied the fundamentals of blood pressure and examined its measuring modalities while focusing on their clinical use and sensing principles to identify material functionalities. Then, we carefully reviewed various categories of functional materials utilized in sensor building blocks allowing for comparative analysis of the performance of a wide range of materials throughout the sensor operational-life cycle. Not only this provides essential data to enhance the materials' properties and optimize their performance, but also, it highlights new perspectives and provides suggestions to develop the next generation pressure sensors for clinical use.
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Affiliation(s)
- Ahmed Al-Qatatsheh
- Faculty of Science, Engineering, and Technology (FSET), Swinburne University of Technology, Melbourne VIC 3122, Australia; (Y.M.); (N.S.)
| | - Yosry Morsi
- Faculty of Science, Engineering, and Technology (FSET), Swinburne University of Technology, Melbourne VIC 3122, Australia; (Y.M.); (N.S.)
| | - Ali Zavabeti
- Department of Chemical Engineering, The University of Melbourne, Parkville VIC 3010, Australia;
| | - Ali Zolfagharian
- Faculty of Science, Engineering and Built Environment, School of Engineering, Deakin University, Waurn Ponds VIC 3216, Australia; (A.Z.); (A.Z.K.)
| | - Nisa Salim
- Faculty of Science, Engineering, and Technology (FSET), Swinburne University of Technology, Melbourne VIC 3122, Australia; (Y.M.); (N.S.)
| | - Abbas Z. Kouzani
- Faculty of Science, Engineering and Built Environment, School of Engineering, Deakin University, Waurn Ponds VIC 3216, Australia; (A.Z.); (A.Z.K.)
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Saleh Gharaie
- Faculty of Science, Engineering and Built Environment, School of Engineering, Deakin University, Waurn Ponds VIC 3216, Australia; (A.Z.); (A.Z.K.)
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Variation in surgical treatment advice for women with stress urinary incontinence: a study using clinical case vignettes. Int Urogynecol J 2020; 31:1153-1161. [PMID: 32253488 PMCID: PMC7270981 DOI: 10.1007/s00192-020-04295-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/26/2020] [Indexed: 12/27/2022]
Abstract
Introduction The aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics. Methods Two hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristics of women with SUI (age, body mass index, SUI type, previous SUI surgery, frequency of leakage, bother, physical status). The gynaecologists scored recommendations for surgery ranging from 1 ‘certainly not’ to 5 ‘certainly yes’. Mean scores were used to calculate the relative impact (‘weight’) of each clinical characteristic. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way. Results The gynaecologists’ overall average recommendation score was 2.9 (interquartile range 2 to 4). All patient characteristics significantly influenced the recommendation scores (p always < 0.001) but their impact was relatively small. SUI type was most important (weight 23%), followed by previous SUI surgery (weight 21%). Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0. Conclusions Surgical treatment advice in response to case vignettes was only minimally influenced by patient characteristics. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied. This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. A considerable number of gynaecologists were reluctant to recommend surgery. Electronic supplementary material The online version of this article (10.1007/s00192-020-04295-4) contains supplementary material.
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Zerah L, Bonnet-Zamponi D, Frappé P, Hauguel-Moreau M, De Rycke Y, Magnier AM, Pautas E, Charles P, Collet JP, Dechartres A, Tubach F. Evaluation of a prescription support-tool for chronic management of oral antithrombotic combinations in adults using clinical vignettes: protocol of a randomised controlled trial. BMJ Open 2019; 9:e025544. [PMID: 31182442 PMCID: PMC6561457 DOI: 10.1136/bmjopen-2018-025544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Improving the appropriateness of prescriptions of oral antithrombotic (AT) drugs, especially AT combinations, is crucial because these drugs are implicated in bleeding events. We developed a prescription support-tool synthesising guidelines on chronic management of oral AT combinations. Our main objective is to assess the impact of this tool on improving the prescription of oral ATs to comply with guidelines. METHODS AND ANALYSIS A randomised controlled trial will be conducted among French general practitioners and cardiologists involved in outpatient settings. Physicians will be invited to participate to an online survey by email via physician associations, social networks or word of mouth. They will be randomised to two arms: the experimental arm (access to the prescription support-tool) or the control arm (no prescription support-tool). Then, all participants will be presented three different clinical vignettes illustrating outpatient clinical situations and will be asked to propose prescriptions for each vignette (number of ATs, type, dosage and duration). A computer-generated randomisation scheme implemented in the online survey will be used to allocate physicians to the experimental or control arm and then stratified by medical specialty. The primary outcome will be fully appropriate prescription of oral ATs ie, that comply with the guidelines in terms of number of drugs, drug class, dosage and duration. To demonstrate a 5% increase in this proportion, we will need to include a minimum of 230 physicians per arm. A logistic mixed model with a clinical vignette-effect and a physician-effect nested in the arm of the study will be used. ETHICS AND DISSEMINATION The Institutional Review Board of Inserm (IRB00003888) approved our research project (no. 18-492). If the prescription support-tool improves the prescription of oral ATs, we will create an interactive web tool and will assess its impact in terms of clinical outcomes in real-life. TRIAL REGISTRATION NUMBER NCT03630874; Pre-results.
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Affiliation(s)
- Lorene Zerah
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Dominique Bonnet-Zamponi
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- OMEDIT, Observatoire du Médicament des Dispositifs Médicaux et de l’Innovation Thérapeutique Ile de France, Paris, France
| | - Paul Frappé
- IRMG, Institut de recherche en médecine générale, Paris, France
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France
| | - Marie Hauguel-Moreau
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Département de cardiologie, Paris, France
| | - Yann De Rycke
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), AP-HP, Paris, France
| | | | - Eric Pautas
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Département de gériatrie, Sorbonne Université, Paris, France
| | - Pierre Charles
- Médecine Interne, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Département de cardiologie, Paris, France
| | - Agnes Dechartres
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), AP-HP, Paris, France
| | - Florence Tubach
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), AP-HP, Paris, France
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Davis LL, Maness JJ. Nurse Practitioner Knowledge of Symptoms of Acute Coronary Syndrome. J Nurse Pract 2019; 15:e9-e12. [DOI: 10.1016/j.nurpra.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ten Cate V, Essers BAB, Prins MH. Determinants of treatment duration in the prevention of recurrent venous thromboembolism: a protocol for a balanced vignette experiment. BMJ Open 2017; 7:e015231. [PMID: 28495816 PMCID: PMC5777455 DOI: 10.1136/bmjopen-2016-015231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/09/2017] [Accepted: 03/17/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a condition that annually occurs in approximately 1‰ of the world's population. Patients who have already had a VTE are at elevated risk for a recurrent VTE. Recurrent events increase the risk of long-term sequelae and can be fatal. Adequate secondary prophylaxis is thus needed to prevent such events. Patients with VTE are often prone to bleeding, and pharmacological prophylaxis exacerbates bleeding risk. Expert opinions on the optimum duration of secondary prophylaxis in VTE still vary substantially. The existence of treatment guidelines has not led to uniformity of VTE secondary prophylaxis strategies, which means that physicians still adhere to individual risk calculi in determining treatment duration. METHODS AND ANALYSIS The aim of this study is to establish what factors lie at the root of this variance in VTE secondary prophylactic treatment strategies, and what risk factors are deemed of particular importance in determining the perceived risks and benefits of variable treatment durations. To do this, we created a survey based on a D-efficient and G-efficient balanced experimental vignette design. This protocol covers all aspects of how this survey was set up and how it was implemented. The analysis of the experimental data will be carried out using mixed-effects methods, which are beneficial in scenarios with high interindividual variance and correlated (eg, repeated-measures) responses. We propose the use of maximal random effects structures insofar as possible. ETHICS AND DISSEMINATION All data are de-identified, and any identifying characteristics of the respondents will not be reported in a final manuscript or elsewhere. A paper describing the expert interviews is currently under peer review. A manuscript that contains the analysis of the results of the experiment described in this protocol is being drafted, and will also be submitted to a peer-reviewed journal.
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Affiliation(s)
- Vincent Ten Cate
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Brigitte AB Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martin H Prins
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Engel J, Poldervaart JM, van der Wulp I, Reitsma JB, de Bruijne MC, Bunge JJH, Cramer MJ, Tietge WJ, Uijlings R, Wagner C. Selecting patients with non-ST-elevation acute coronary syndrome for coronary angiography: a nationwide clinical vignette study in the Netherlands. BMJ Open 2017; 7:e011213. [PMID: 28104706 PMCID: PMC5253531 DOI: 10.1136/bmjopen-2016-011213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Cardiac guidelines recommend that the decision to perform coronary angiography (CA) in patients with Non-ST-Elevation Acute Coronary Syndrome (NST-ACS) is based on multiple factors. It is, however, unknown how cardiologists weigh these factors in their decision-making. The aim was to investigate the importance of different clinical characteristics, including information derived from risk scores, in the decision-making of Dutch cardiologists regarding performing CA in patients with suspected NST-ACS. DESIGN A web-based survey containing clinical vignettes. SETTING AND PARTICIPANTS Registered Dutch cardiologists were approached to complete the survey, in which they were asked to indicate whether they would perform CA for 8 vignettes describing 7 clinical factors: age, renal function, known coronary artery disease, persistent chest pain, presence of risk factors, ECG findings and troponin levels. Cardiologists were divided into two groups: group 1 received vignettes 'without' a risk score present, while group 2 completed vignettes 'with' a risk score present. RESULTS 129 (of 946) cardiologists responded. In both groups, elevated troponin levels and typical ischaemic changes (p<0.001) made cardiologists decide more often to perform CA. Severe renal dysfunction (p<0.001) made cardiologists more hesitant to decide on CA. Age and risk score could not be assessed independently, as these factors were strongly associated. Inspecting the factors together showed, for example, that cardiologists were more hesitant to perform CA in elderly patients with high-risk scores than in younger patients with intermediate risk scores. CONCLUSIONS When deciding to perform in-hospital CA (≤72 hours after patient admission) in patients with suspected NST-ACS, cardiologists tend to rely mostly on troponin levels, ECG changes and renal function. Future research should focus on why CA is less often recommended in patients with severe renal dysfunction, and in elderly patients with high-risk scores. In addition, the impact of age and risk score on decision-making should be further investigated.
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Affiliation(s)
- Josien Engel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith M Poldervaart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ineke van der Wulp
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen J H Bunge
- Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter J Tietge
- Department of Cardiology, Alrijne Ziekenhuis, Leiden, The Netherlands
| | - Ruben Uijlings
- Department of Cardiology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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