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Lautz Z, Kautz-Freimuth S, Shukri A, Redaèlli M, Rhiem K, Schmutzler R, Stock S. Predictors of knowledge and knowledge gain after decision aid use among women with BRCA1/2 pathogenic variants. PATIENT EDUCATION AND COUNSELING 2024; 124:108248. [PMID: 38513456 DOI: 10.1016/j.pec.2024.108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/01/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To identify factors contributing to baseline knowledge in women with BRCA1/2 pathogenic variants (PVs) and knowledge gain after decision aid (DA) use. METHODS Women with PVs in BRCA1 or BRCA2 genes were randomly assigned to an intervention group (IG) receiving DAs or a control group (CG). Of the total sample, 417 completed the baseline survey and were included in this analysis. Two multiple regression analyses were conducted: baseline data on socio-demographic, medical, decision-related and psychological variables were used to identify predictors for (1) baseline knowledge within the total group and (2) knowledge gain within the IG after DA use three months post study inclusion. RESULTS At baseline, higher education status, no breast cancer history, and lower decisional conflict related to higher knowledge within the total group. After DA use within the IG, higher baseline scores for decisional conflict predicted higher knowledge gain, and higher baseline scores for depression and intrusion predicted lower knowledge gain. CONCLUSIONS This study identified predictors of baseline knowledge and knowledge gain after DA use in women with BRCA1/2 PVs. PRACTICE IMPLICATIONS Awareness of facilitating and hindering factors on these women's knowledge can improve understanding of their health literacy and enable further targeted support interventions.
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Affiliation(s)
- Zoë Lautz
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany.
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Kerstin Rhiem
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Rita Schmutzler
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
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Woo BFY, Tam WWS, Rangpa T, Liau WF, Nathania J, Lim TW. A Nurse-Led Integrated Chronic Care E-Enhanced Atrial Fibrillation (NICE-AF) Clinic in the Community: A Preliminary Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084467. [PMID: 35457336 PMCID: PMC9026946 DOI: 10.3390/ijerph19084467] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
The current physician-centric model of care is not sustainable for the rising tide of atrial fibrillation. The integrated model of care has been recommended for managing atrial fibrillation. This study aims to provide a preliminary evaluation of the effectiveness of a Nurse-led Integrated Chronic care E-enhanced Atrial Fibrillation (NICE-AF) clinic in the community. The NICE-AF clinic was led by an advanced practice nurse (APN) who collaborated with a family physician. The clinic embodied integrated care and shifted from hospital-based, physician-centric care. Regular patient education, supplemented by a specially curated webpage, fast-tracked appointments for hospital-based specialised investigations, and teleconsultation with a hospital-based cardiologist were the highlights of the clinic. Forty-three participants were included in the six-month preliminary evaluation. No significant differences were observed in cardiovascular hospitalisations (p-value = 0.102) and stroke incidence (p-value = 1.00) after attending the NICE-AF clinic. However, significant improvements were noted for AF-specific QoL (p = 0.001), AF knowledge (p < 0.001), medication adherence (p = 0.008), patient satisfaction (p = 0.020), and depression (p = 0004). The preliminary evaluation of the NICE-AF clinic demonstrated the clinical utility of this new model of integrated care in providing safe and effective community-based AF care. Although a full evaluation is pending, the preliminary results highlighted its promising potential to be expanded into a permanent, larger-scale service.
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Affiliation(s)
- Brigitte Fong Yeong Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
- Correspondence: ; Tel.: +65-6601-6812
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
| | - Taiju Rangpa
- Bukit Batok—Medical, National University Polyclinics, National University Health System, Singapore 659164, Singapore;
| | - Wei Fong Liau
- Bukit Batok—Nursing, National University Polyclinics, National University Health System, Singapore 659164, Singapore;
| | - Jennifer Nathania
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119228, Singapore;
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Freedman B, Hindricks G, Banerjee A, Baranchuk A, Ching CK, Du X, Fitzsimons D, Healey JS, Ikeda T, Lobban TCA, Mbakwem A, Narasimhan C, Neubeck L, Noseworthy P, Philbin DM, Pinto FJ, Rwebembera J, Schnabel RB, Svendsen JH, Aguinaga L, Arbelo E, Böhm M, Farhan HA, Hobbs FDR, Martínez-Rubio A, Militello C, Naik N, Noubiap JJ, Perel P, Piñeiro DJ, Ribeiro AL, Stepinska J. World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update. Glob Heart 2021; 16:41. [PMID: 34211827 PMCID: PMC8162289 DOI: 10.5334/gh.1023] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.
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Affiliation(s)
- Ben Freedman
- Heart Research Institute, University of Sydney, Sydney, AU
| | | | | | | | | | - Xin Du
- Beijing Anzhen Hospital, Capital Medical University, CN
| | | | | | | | - Trudie C. A. Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford Upon Avon, UK
| | - Amam Mbakwem
- Lagos University Teaching Hospital, Idi Araba, Lagos, NG
| | | | | | | | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | | | | | | | | | - Elena Arbelo
- Hospital Clinic de Barcelona, Universitat de Barcelona, ES
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Hornburg/Saar, DE
| | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, IN
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Bazal P, Gea A, Navarro AM, Salas-Salvadó J, Corella D, Alonso-Gómez A, Fitó M, Muñoz-Bravo C, Estruch R, Fiol M, Lapetra J, Serra-Majem L, Ros E, Rekondo J, Muñoz MA, Basora J, Sorlí JV, Toledo E, Martínez-González MA, Ruiz-Canela M. Caffeinated coffee consumption and risk of atrial fibrillation in two Spanish cohorts. Eur J Prev Cardiol 2020; 28:648-657. [PMID: 32131628 DOI: 10.1177/2047487320909065] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/05/2020] [Indexed: 01/31/2023]
Abstract
AIMS The association between caffeinated coffee consumption and atrial fibrillation remains unclear. Recent studies suggest an inverse association only between a moderate caffeinated coffee consumption and atrial fibrillation, but others have reported no association. The aim of our study was to prospectively assess the association between caffeinated coffee consumption and atrial fibrillation in two Spanish cohorts, one of adults from a general population and another of elderly participants at high cardiovascular risk. METHODS AND RESULTS We included 18,983 and 6479 participants from the 'Seguimiento Universidad de Navarra' (SUN) and 'Prevención con Dieta Mediterránea' (PREDIMED) cohorts, respectively. Participants were classified according to their caffeinated coffee consumption in three groups: ≤3 cups/month, 1-7 cups/week, and >1 cup/day. We identified 97 atrial fibrillation cases after a median follow-up of 10.3 years (interquartile range 6.5-13.5), in the SUN cohort and 250 cases after 4.4 years median follow-up (interquartile range 2.8-5.8) in the PREDIMED study. No significant associations were observed in the SUN cohort although a J-shaped association was suggested. A significant inverse association between the intermediate category of caffeinated coffee consumption (1-7 cups/week) and atrial fibrillation was observed in PREDIMED participants with a multivariable-adjusted hazard ratio = 0.53 (95% confidence interval 0.36-0.79) when compared with participants who did not consume caffeinated coffee or did it only occasionally. No association was found for higher levels of caffeinated coffee consumption (>1 cup per day), hazard ratio = 0.79 (95% confidence interval 0.49-1.28). In the meta-analysis of both PREDIMED and SUN studies, the hazard ratio for intermediate consumption of caffeinated coffee was 0.60 (95% confidence interval 0.44-0.82) without evidence of heterogeneity. Similar findings were found for the association between caffeine intake and atrial fibrillation risk. CONCLUSION Intermediate levels of caffeinated coffee consumption (1-7 cups/week) were associated with a reduction in atrial fibrillation risk in two prospective Mediterranean cohorts.
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Affiliation(s)
- P Bazal
- Department of Preventive Medicine and Public Health, University of Navarra, Spain.,Servicio Navarro de Salud-Osasunbidea, Spain
| | - A Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain
| | - A M Navarro
- Department of Preventive Medicine and Public Health, University of Navarra, Spain.,Servicio Navarro de Salud-Osasunbidea, Spain
| | - J Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutriciœ Humana, Hospital Universitari San Joan de Reus, Institut d'Investigació Pere Virgili (IISPV), Spain
| | - D Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Preventive Medicine, University of Valencia, Spain
| | - A Alonso-Gómez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Cardiology, University Hospital Araba, Spain
| | - M Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute (IMIM), Spain
| | - C Muñoz-Bravo
- Department of Public Health, University of Malaga, Spain
| | - R Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Internal Medicine, Institut d'Investigacions Biomèdiques, August Pi i Sunyer Hospital Clinic, University of Barcelona, Spain
| | - M Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Illes Balears Health Research Institute (IdISBa), Spain
| | - J Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria de Sevilla, Spain
| | - L Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and CHUIMI Canarian Health Service, Spain
| | - E Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clinic, Spain
| | - J Rekondo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Cardiology, University Hospital Araba, Spain
| | - M A Muñoz
- Gerència Territorial de Barcelona, Institut Català de la Salut, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Spain
| | - J Basora
- Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Unitat de Nutriciœ Humana, Hospital Universitari San Joan de Reus, Institut d'Investigació Pere Virgili (IISPV), Spain
| | - J V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Preventive Medicine, University of Valencia, Spain
| | - E Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain
| | - M A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, USA
| | - M Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain
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