1
|
Tang O, Kou M, Lu Y, Miller ER, Brady T, Dennison-Himmelfarb C, More A, Neupane D, Appel L, Matsushita K. Simplified hypertension screening approaches with low misclassification and high efficiency in the United States, Nepal, and India. J Clin Hypertens (Greenwich) 2021; 23:1865-1871. [PMID: 34477290 PMCID: PMC8678738 DOI: 10.1111/jch.14299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
Standard triplicate blood pressure (BP) measurements pose time barriers to hypertension screening, especially in resource‐limited settings. We assessed the implications of simplified approaches using fewer measurements with adults (≥18 years old) not using anti‐hypertensive medications from the US National Health and Nutrition Examination Survey 1999‐2016 (n = 30 614), and two datasets from May Measurement Month 2017‐2018 (n = 14 795 for Nepal and n = 6 771 for India). We evaluated the proportion of misclassification of hypertension when employing the following simplified approaches: using only 1st BP, only 2nd BP, 2nd if 1st BP in a given range (otherwise using 1st), and average of 1st and 2nd BP. Hypertension was defined as average of 2nd and 3rd systolic BP ≥140 and/or diastolic BP ≥90 mm Hg. Using only the 1st BP, the proportion of missed hypertension ranged from 8.2%–12.1% and overidentified hypertension from 4.3%–9.1%. Using only 2nd BP reduced the misclassification considerably (corresponding estimates, 4.9%–6.4% for missed hypertension and 2.0%–4.4% for overidentified hypertension) but needed 2nd BP in all participants. Using 2nd BP if 1st BP ≥130/80 demonstrated similar estimates of missed hypertension (3.8%–8.1%) and overidentified hypertension (2.0%–3.9%), but only required a 2nd BP in 33.8%–59.8% of participants. In conclusion, a simplified approach utilizing 1st BP supplemented by 2nd BP in some individuals has low misclassification rates and requires approximately half of the total number of measurements compared to the standard approach, and thus can facilitate screening in resource‐constrained settings.
Collapse
Affiliation(s)
- Olive Tang
- Johns Hopkins University, Baltimore, MD, USA
| | - Minghao Kou
- Johns Hopkins University, Baltimore, MD, USA
| | - Yifei Lu
- University of North Carolina, Chapel Hill, NC, USA
| | | | - Tammy Brady
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Arun More
- Rural Health Progress Trust, Osmanabad, India
| | - Dinesh Neupane
- Johns Hopkins University, Baltimore, MD, USA.,Nepal Development Society, Bharatpur, Nepal
| | | | | |
Collapse
|
2
|
Han HR, Xu A, Mendez KJW, Okoye S, Cudjoe J, Bahouth M, Reese M, Bone L, Dennison-Himmelfarb C. Exploring community engaged research experiences and preferences: a multi-level qualitative investigation. Res Involv Engagem 2021; 7:19. [PMID: 33785074 PMCID: PMC8008581 DOI: 10.1186/s40900-021-00261-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Community engagement may make research more relevant, translatable, and sustainable, hence improving the possibility of reducing health disparities. The purpose of this study was to explore strategies for community engagement adopted by research teams and identify areas for enhancing engagement in future community engaged research. METHODS The Community Engagement Program of the Johns Hopkins Institute for Clinical and Translational Research hosted a forum to engage researchers and community partners in group discussion to reflect on their diverse past and current experiences in planning, implementing, and evaluating community engagement in health research. A total of 50 researchers, research staff, and community partners participated in five concurrent semi-structured group interviews and a whole group wrap-up session. Group interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. RESULTS Four themes with eight subthemes were identified. Main themes included: Community engagement is an ongoing and iterative process; Community partner roles must be well-defined and clearly communicated; Mutual trust and transparency are central to community engagement; and Measuring community outcomes is an evolving area. Relevant subthemes were: engaging community partners in various stages of research; mission-driven vs. "checking the box"; breadth and depth of engagement; roles of community partner; recruitment and selection of community partners; building trust; clear communication for transparency; and conflict in community engaged research. CONCLUSION The findings highlight the benefits and challenges of community engaged research. Enhanced capacity building for community engagement, including training and communication tools for both community and researcher partners, are needed.
Collapse
Affiliation(s)
- Hae-Ra Han
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA.
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA.
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ashley Xu
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Kyra J W Mendez
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Safiyyah Okoye
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mona Bahouth
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melanie Reese
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA
- Older Women Embracing Life, Baltimore, MD, USA
| | - Lee Bone
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cheryl Dennison-Himmelfarb
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
- The Johns Hopkins Institute for Clinical and Translational Research, Community Engagement Program, Baltimore, MD, USA
| |
Collapse
|
3
|
Tang O, Miller ER, Appel L, Neupane D, Lu Y, Brady T, Moran A, Dennison-Himmelfarb C, Matsushita K. Abstract P192: Implications of a Simplified Hypertension Screening Approach for Low-and Middle-Income Countries. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.p192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In low- and middle- income settings, standardized protocols that require triplicate blood pressure (BP) readings pose substantial logistical barriers to hypertension (HTN) screening. We assessed algorithms using fewer measurements.
Methods:
We evaluated the efficiency, % HTN missed and % misdiagnosed as HTN associated with algorithms based on the 1st and/or 2nd measurements. For reference, we defined HTN as recommended by the WHO, i.e. average of 2nd and 3rd BP ≥ 140/90. We focused on 11,999 and 7,382 adults without anti-HTN medication use in Nepal and India, respectively, from May Measurement Month 2017-2018 and contrasted them with 21,751 from the US National Health and Nutrition Examination Survey 1999-2014.
Results:
The prevalence of HTN was 18.8% in Nepal, 27.0% in India, and 10.2% in the US. Using only the 1st BP, 7.8%, 11.7%, and 10.1% of cases would be missed in each country respectively. The % of misdiagnosed HTN would be 9.9%, 9.4%, and 4.2%, respectively. Using a 2nd BP among those with a 1
st
BP ≥ 135/85 (“Two-Step Simple”) missed fewer cases (4.7%, 9.4%, and 7.7%), and misdiagnosed fewer people (2.8%, 3.5%, and 1.6%). Under this approach, 36.3%, 44.1%, and 18.7% would receive a 2
nd
BP reading. Alternative, more complex, algorithms were able to further minimize misclassification and improve efficiency (
Table
).
Conclusions:
Using screening data from Nepal, India, and the US, we found several algorithms based on <3 BP readings had low misclassification rates. These algorithms reduce the total number of measurements by more than half from the standard triplicate protocol and appear to be practical for large-scale screening in resource-constrained settings.
Collapse
Affiliation(s)
| | | | | | | | - Yifei Lu
- Johns Hopkins Univ, Baltimore, MD
| | | | | | | | | |
Collapse
|
4
|
Tankumpuan T, Asano R, Koirala B, Dennison-Himmelfarb C, Sindhu S, Davidson PM. Heart failure and social determinants of health in Thailand: An integrative review. Heliyon 2019; 5:e01658. [PMID: 31193015 PMCID: PMC6513778 DOI: 10.1016/j.heliyon.2019.e01658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/10/2018] [Accepted: 05/01/2019] [Indexed: 12/26/2022] Open
Abstract
Background Heart failure is a highly burdensome syndrome and is rapidly increasing in prevalence in low and middle-income countries and outcomes are influenced at the level of the patient, provider and health system. Understanding heart failure beyond a biomedical perspective and the relationship between health outcomes and social determinants of health is critical for informing policy development and improving health outcomes. Aim To identify the social determinants of health for improving health outcomes for individuals with heart failure in Thailand. Method This integrative review included studies published between January 1, 2008, and March 31, 2016 in both the Thai and English language identified through searching Scopus, PubMed, and CINAHL. Results Six experimental, eight descriptive and two qualitative studies were identified met the inclusion and exclusion criteria. The majority of study participants were elderly, female, had low-education and income levels, were participating in a universal coverage scheme and living in a rural setting. All interventions were delivered at the level of the individual, focusing on education to improve knowledge, self-care, and functional status. Findings showed an improvement in health outcomes which were moderated by social determinants of health such as gender and income. Conclusion As the burden of heart failure increases in Thailand and other emerging economies, developing culturally appropriate, affordable and acceptable models of intervention considering social determinants of health is necessary.
Collapse
Affiliation(s)
| | - Reiko Asano
- The Johns Hopkins University School of Nursing, United States
| | - Binu Koirala
- The Johns Hopkins University School of Nursing, United States
| | | | | | - Patricia M Davidson
- The Johns Hopkins University School of Nursing, United States.,University of Technology Sydney, Australia
| |
Collapse
|
5
|
Awoke MS, Baptiste DL, Davidson P, Roberts A, Dennison-Himmelfarb C. A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure. Contemp Nurse 2019; 55:15-26. [DOI: 10.1080/10376178.2019.1568198] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Martha S. Awoke
- Department of Case Management, Medstar Georgetown University of Hospital, 3800 Reservoir Rd. NW, Washington, DC 20007, USA
| | - Diana-Lyn Baptiste
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, 525 N. Wolf Street, Baltimore, MD 21205, USA
| | - Patricia Davidson
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, 525 N. Wolf Street, Baltimore, MD 21205, USA
| | - Allen Roberts
- Department of Case Management, Medstar Georgetown University of Hospital, 3800 Reservoir Rd. NW, Washington, DC 20007, USA
| | - Cheryl Dennison-Himmelfarb
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, 525 N. Wolf Street, Baltimore, MD 21205, USA
| |
Collapse
|
6
|
Heins SE, Wozniak AW, Colantuoni E, Sepulveda KA, Mendez-Tellez PA, Dennison-Himmelfarb C, Needham DM, Dinglas VD. Factors associated with missed assessments in a 2-year longitudinal study of acute respiratory distress syndrome survivors. BMC Med Res Methodol 2018; 18:55. [PMID: 29907087 PMCID: PMC6003179 DOI: 10.1186/s12874-018-0508-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 05/09/2018] [Indexed: 01/17/2023] Open
Abstract
Background To evaluate participant-related variables associated with missing assessment(s) at follow-up visits during a longitudinal research study. Methods This is a prospective, longitudinal, multi-site study of 196 acute respiratory distress syndrome (ARDS) survivors. More than 30 relevant sociodemographic, physical status, and mental health variables (representing participant characteristics prior to ARDS, at hospital discharge, and at the immediately preceding follow-up visit) were evaluated for association with missed assessments at 3, 6, 12, and 24-month follow-up visits (89–95% retention rates), using binomial logistic regression. Results Most participants were male (56%), white (58%), and ≤ high school education (64%). Sociodemographic characteristics were not associated with missed assessments at the initial 3-month visit or subsequent visits. The number of dependencies in Activities of Daily Living (ADLs) at hospital discharge was associated with higher odds of missed assessments at the initial visit (OR: 1.26, 95% CI: 1.12, 1.43). At subsequent 6-, 12-, and 24 months visits, post-hospital discharge physical and psychological status were not associated with subsequent missed assessments. Instead, the following were associated with lower odds of missed assessments: indicators of poorer health prior to hospital admission (inability to walk 5 min (OR: 0.46; 0.23, 0.91), unemployment due to health (OR: 0.47; 0.23, 0.96), and alcohol abuse (OR: 0.53; 0.28, 0.97)) and having the preceding visit at the research clinic rather than at home/facility, or by phone/mail (OR: 0.54; 0.31, 0.96). Inversely, variables associated with higher odds of missed assessments at subsequent visits include: functional dependency prior to hospital admission (i.e. dependency with > = 2 Instrumental Activities of Daily Living (IADLs) (OR: 1.96; 1.08, 3.52), and missing assessments at preceding visit (OR: 2.26; 1.35, 3.79). Conclusions During the recovery process after hospital discharge, dependencies in physical functioning (e.g. ADLs, IADLs) prior to hospitalization and at hospital discharge were associated with higher odds of missed assessments. Conversely, other indicators of poorer health at baseline were associated with lower odds of missed assessments after the initial post-discharge visit. To reduce missing assessments, longitudinal clinical research studies may benefit from focusing additional resources on participants with dependencies in physical functioning prior to hospitalization and at hospital discharge. Electronic supplementary material The online version of this article (10.1186/s12874-018-0508-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sara E Heins
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy W Wozniak
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristin A Sepulveda
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, 1830 E. Monument Street, 5th floor, Baltimore, MD, 21287, USA
| | - Pedro A Mendez-Tellez
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl Dennison-Himmelfarb
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Institute for Clinical and Translational Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, 1830 E. Monument Street, 5th floor, Baltimore, MD, 21287, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, 1830 E. Monument Street, 5th floor, Baltimore, MD, 21287, USA.
| |
Collapse
|
7
|
Newhouse RP, Johantgen M, Thomas SA, Trocky NM, Dennison-Himmelfarb C, Cheon J, Miller W, Gray T, Pruitt R. Engaging patients with heart failure into the design of health system interventions: Impact on research methods. Geriatr Nurs 2017; 38:342-346. [PMID: 28228246 DOI: 10.1016/j.gerinurse.2016.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to engage patients with heart failure (HF) to assess if changes are needed in a research study design, methods and outcomes when transferring interventions used in urban/community hospitals to rural hospital settings. A qualitative structured interview was conducted with eight patients with a diagnosis of HF admitted to two rural hospitals. Patients validated the study design, measures and outcomes, but identified one area that should be added to the study protocol, symptom experience. Results validated that the intervention, methods and outcomes for the planned study were important, but modifications to the study protocol resulted. Patient engagement in the conceptualization of research is essential to guide patient-centered studies.
Collapse
Affiliation(s)
- Robin P Newhouse
- Indiana University School of Nursing, 610 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Meg Johantgen
- University of Maryland Baltimore, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | - Sue A Thomas
- University of Maryland Baltimore, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | - Nina M Trocky
- University of Maryland Baltimore, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | | | - Jooyoung Cheon
- School of Nursing, Sungshin Women's University, 76ga-gil 55, 01133, Republic of Korea
| | - Wanda Miller
- Riverside Tappahannock Hospital, 618 Hospital Road, Tappahannock, VA 22560, USA
| | - Tracy Gray
- Riverside Tappahannock Hospital, 618 Hospital Road, Tappahannock, VA 22560, USA
| | - Robin Pruitt
- Riverside Shore Memorial Hospital, 9507 Hospital Avenue, Nassawadox, VA 23413, USA
| |
Collapse
|
8
|
Luu NP, Pitts S, Petty B, Sawyer MD, Dennison-Himmelfarb C, Boonyasai RT, Maruthur NM. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review. J Gen Intern Med 2016; 31:417-25. [PMID: 26691310 PMCID: PMC4803688 DOI: 10.1007/s11606-015-3547-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/03/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. METHODS We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. RESULTS Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). DISCUSSION The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.
Collapse
Affiliation(s)
- Ngoc-Phuong Luu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Samantha Pitts
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brent Petty
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melinda D Sawyer
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Cheryl Dennison-Himmelfarb
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.,Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Romsai Tony Boonyasai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Nisa M Maruthur
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| |
Collapse
|
9
|
Nogueira-Silva L, Sá-Sousa A, Lima MJ, Monteiro A, Dennison-Himmelfarb C, Fonseca JA. Translation and cultural adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale to Portuguese. Rev Port Cardiol 2016; 35:93-7. [PMID: 26852304 DOI: 10.1016/j.repc.2015.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/14/2015] [Accepted: 07/24/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Hypertension is an extremely prevalent disease worldwide and hypertension control rates remain low. Lack of adherence contributes to poor control and to cardiovascular events. No questionnaire in Portuguese is readily available for the assessment of adherence to antihypertensive drugs. We aimed to perform a translation and cultural adaptation to Portuguese of the Hill-Bone Compliance to High Blood Pressure Therapy Scale, a validated instrument to measure adherence in hypertensive patients. METHODS A formal process was employed, consisting of a forward translation by two independent translators and a back translation by a third translator. Discrepancies were resolved after each step. Hypertensive patients were involved to identify and resolve phrasing and wording difficulties and misunderstandings. RESULTS The forward and back translation did not produce significant discrepancies. However, important issues were identified when the questionnaire was presented to patients, which led to changes in the wording of the questions and in the format of the questionnaire. CONCLUSION Questionnaires are important instruments to assess adherence to therapy, particularly in hypertension. A formal translation and cultural adaptation process ensures that the new version maintains the same concepts as the original. After translation, several changes were necessary to ensure that the questionnaire was understandable by elderly, low literacy patients, such as the majority of hypertensive patients. We propose a Portuguese version of the Hill-Bone Compliance Scale, which will require validation in further studies.
Collapse
Affiliation(s)
- Luís Nogueira-Silva
- Serviço de Medicina Interna, Centro Hospitalar S. João, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Universidade do Porto, Portugal.
| | - Ana Sá-Sousa
- CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Universidade do Porto, Portugal
| | - Maria João Lima
- Serviço de Medicina Interna, Centro Hospitalar S. João, Porto, Portugal
| | | | | | - João A Fonseca
- CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Universidade do Porto, Portugal; Unidade de Alergologia, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
| |
Collapse
|
10
|
Nogueira-Silva L, Sá-Sousa A, Lima MJ, Monteiro A, Dennison-Himmelfarb C, Fonseca JA. Translation and cultural adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale to Portuguese. Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2015.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Robinson KA, Dinglas VD, Sukrithan V, Yalamanchilli R, Mendez-Tellez PA, Dennison-Himmelfarb C, Needham DM. Updated systematic review identifies substantial number of retention strategies: using more strategies retains more study participants. J Clin Epidemiol 2015; 68:1481-7. [PMID: 26186981 DOI: 10.1016/j.jclinepi.2015.04.013] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/17/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The retention of participants in studies is important for the validity of research. We updated our prior systematic review (2005) to assess retention strategies for in-person follow-up in health care studies. METHODS We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Cochrane Controlled Trials Register, Cochrane Methodology Register, and Embase (August 2013) for English-language reports of studies that described retention strategies for in-person follow-up in health care studies. We abstracted each retention strategy, and two authors independently classified each retention strategy with one of the themes developed in our prior review. RESULTS We identified 88 studies (67 newly identified studies), six of which were designed to compare retention strategies, whereas the remainder described retention strategies and retention rates. There were 985 strategies abstracted from the descriptive studies (617 from new studies), with a median (interquartile range) number of strategies per study of 10 (7 to 17) and a median (interquartile range) number of themes per study of 6 (4 to 7). Financial incentives were used in 47 (57%) of the descriptive studies. We classified 28% of the strategies under the theme of "contact and scheduling methods," with 83% of the identified studies using at least one strategy within this theme. The number of strategies used was positively correlated with retention rate (P = 0.027), but the number of themes was not associated with retention rate (P = 0.469). CONCLUSION The number of studies describing retention strategies has substantially increased since our prior review. However, the lack of comparative studies and the heterogeneity in the types of strategies, participant population and study designs, prohibits synthesis to determine the types of cohort retention strategies that were most effective. However, using a larger number of retention strategies, across five or six different themes, appears to retain more study participants.
Collapse
Affiliation(s)
- Karen A Robinson
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA.
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| | - Vineeth Sukrithan
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| | - Ramakrishna Yalamanchilli
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| | - Pedro A Mendez-Tellez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Cheryl Dennison-Himmelfarb
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Baltimore Street, Baltimore, MD 21287, USA
| |
Collapse
|
12
|
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014. [PMID: 24352797 DOI: 10.1001/jama.2013.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
Collapse
Affiliation(s)
| | | | | | - William C Cushman
- Memphis Veterans Affairs Medical Center and the University of Tennessee, Memphis
| | | | | | | | | | - Thomas D MacKenzie
- Denver Health and Hospital Authority and the University of Colorado School of Medicine, Denver
| | | | | | | | | | | | | | - Andrew S Narva
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Eduardo Ortiz
- at the time of the project,National Heart, Lung, and Blood Institute, Bethesda, Maryland17currently with ProVation Medical, Wolters Kluwer Health, Minneapolis, Minnesota
| |
Collapse
|
13
|
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507-20. [PMID: 24352797 DOI: 10.1001/jama.2013.284427] [Citation(s) in RCA: 5261] [Impact Index Per Article: 526.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
Collapse
Affiliation(s)
| | | | | | - William C Cushman
- Memphis Veterans Affairs Medical Center and the University of Tennessee, Memphis
| | | | | | | | | | - Thomas D MacKenzie
- Denver Health and Hospital Authority and the University of Colorado School of Medicine, Denver
| | | | | | | | | | | | | | - Andrew S Narva
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Eduardo Ortiz
- at the time of the project,National Heart, Lung, and Blood Institute, Bethesda, Maryland17currently with ProVation Medical, Wolters Kluwer Health, Minneapolis, Minnesota
| |
Collapse
|
14
|
Davis K, Dennison-Himmelfarb C, Allen J, Mintzer M, Hayat M, Rotman S. 5. Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment. Heart Lung 2012. [DOI: 10.1016/j.hrtlng.2012.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Caslin E, Beitler D, Arthur D, Dennison-Himmelfarb C. 8. Information technology improves heart failure core measure compliance and readmission rates. Heart Lung 2011. [DOI: 10.1016/j.hrtlng.2011.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|