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Coeckelberghs E, Bislenghi G, Wolthuis A, Teunkens A, Dewinter G, Coppens S, Vanhaecht K, D'Hoore A. Quality indicators for ambulatory colectomy: literature search and expert consensus. Surg Endosc 2024; 38:1894-1901. [PMID: 38316661 PMCID: PMC10978605 DOI: 10.1007/s00464-023-10660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/09/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Care for patients undergoing elective colectomy has become increasingly standardized using Enhanced Recovery Programs (ERP). ERP, encorporating minimally invasive surgery (MIS), decreased postoperative morbidity and length of stay (LOS). However, disruptive changes are needed to safely introduce colectomy in an ambulatory or same-day discharge (SDD) setting. Few research groups showed the feasibility of ambulatory colectomy. So far, no minimum standards for the quality of care of this procedure have been defined. This study aims to identify quality indicators (QIs) that assess the quality of care for ambulatory colectomy. METHODS A literature search was performed to identify recommendations for ambulatory colectomy. Based on that search, a set of QIs was identified and categorized into seven domains: preparation of the patient (pre-admission), anesthesia, surgery, in-hospital monitoring, home monitoring, feasibility, and clinical outcomes. This list was presented to a panel of international experts (surgeons and anesthesiologists) in a 1 round Delphi to assess the relevance of the proposed indicators. RESULTS Based on the literature search (2010-2021), 3841 results were screened on title and abstract for relevant information. Nine papers were withheld to identify the first set of QIs (n = 155). After excluding duplicates and outdated QIs, this longlist was narrowed down to 88 indicators. Afterward, consensus was reached in a 1 round Delphi on a final list of 32 QIs, aiming to be a comprehensive set to evaluate the quality of ambulatory colectomy care. CONCLUSION We propose a list of 32 QI to guide and evaluate the implementation of ambulatory colectomy.
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Affiliation(s)
- Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - An Teunkens
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Geertrui Dewinter
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Steve Coppens
- Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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2
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Ratti M, Milicia O, Rescinito R, Coeckelberghs E, Seys D, Vanhaecht K, Panella M. The determinants of expert opinion in the development of care pathways: insights from an exploratory cluster analysis. BMC Health Serv Res 2023; 23:211. [PMID: 36869326 PMCID: PMC9983158 DOI: 10.1186/s12913-023-09139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/01/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND We performed a secondary exploratory cluster analysis on the data collected from the validation phase of the study leading to the development of the model care pathway (CP) for Myasthenia Gravis (MG), in which a panel of 85 international experts were asked some characteristics about themselves and their opinion about the model CP. Our aim was to identify which characteristics of the experts play a role in the genesis of their opinion. METHODS We extracted the questions probing an opinion and those describing a characteristic of the expert from the original questionnaire. We performed a multiple correspondence analysis (MCA) and a subsequent hierarchical clustering on principal component (HCPC) on the opinion variables, integrating the characteristic variables as supplementary (predicted). RESULTS After reducing the dimensionality of the questionnaire to three dimensions we noticed that the not-appropriateness judgement of the clinical activities may overlap with the completeness one. From the HCPC it seems that the working setting of the expert may play a crucial role in determining the opinion about the setting of the sub-processes of MG: shifting from a cluster where the experts do not work in sub-specialist settings to one where the experts are working in them, the opinion changes accordingly from a mono-disciplinary setting to a multi-disciplinary one. Another interesting result is that the experience in neuromuscular diseases (NMD) measured in years and the expert typology (whether general neurologist or NMD expert) seem not to contribute significantly to the opinions. CONCLUSIONS These findings might indicate a poor ability of the expert to discriminate what is not appropriate from what is not complete. Also, the opinion of the expert might be influenced by the working setting, but not by the experience in NMD (as measured in years).
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Affiliation(s)
- Matteo Ratti
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy.
| | - Osvaldo Milicia
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy
| | - Riccardo Rescinito
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Louvain-University of Leuven, Leuven, Belgium
- European Pathway Association, Louvain, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Louvain-University of Leuven, Leuven, Belgium
- European Pathway Association, Louvain, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Louvain-University of Leuven, Leuven, Belgium
- European Pathway Association, Louvain, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UNIUPO), Via Solaroli,17, 28100, Novara, Italy
- European Pathway Association, Louvain, Belgium
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3
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Lens C, Coeckelberghs E, Seys D, Demeestere J, Weltens C, Vanhaecht K, Lemmens R. Variation in stroke care at the hospital level: A cross-sectional multicenter study. Front Neurol 2022; 13:1004901. [PMID: 36313511 PMCID: PMC9606690 DOI: 10.3389/fneur.2022.1004901] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionStroke is one of the leading causes of mortality and disability. Improving patient outcomes can be achieved by improving stroke care and adherence to guidelines. Since wide variation in adherence rates for stroke guidelines still exists, we aimed to describe and compare stroke care variability within Belgian hospitals.Materials and methodsAn observational, multicenter study was performed in 29 Belgian hospitals. We retrospectively collected patient characteristics, quality indicators, and time metrics from the last 30 consecutive patients per hospital, diagnosed with ischemic stroke in 2019 with structured questionnaires. Mean adherence ratios (%) ± SD (minimum – maximum) were calculated.ResultsWe analyzed 870 patient records from 29 hospitals. Results showed large inter- and intrahospitals variations in adherence for various indicators. Almost all the patients received brain imaging (99.7%) followed by admission at a stroke unit in 82.9% of patients. Of patients not receiving thrombolysis, 92.5% of patients were started on antithrombotic drugs. Indicators with moderate median adherence but large interhospital variability were glycemia monitoring [82.3 ± 16.7% (26.7–100.0%)], performing clinical neurological examination and documentation of stroke severity [63.1 ± 36.8% (0–100%)], and screening for activities of daily living [51.1 ± 40.3% (0.0–100.0%)]. Other indicators lacked adequate adherence: swallowing function screening [37.0 ± 30.4% (0.0–93.3%)], depression screening [20.2 ± 35.8% (0.0–100%)], and timely body temperature measurement [15.1 ± 17.0% (0.0–60%)].ConclusionWe identified high adherence to guidelines for some indicators, but lower rates with large interhospital variability for other recommendations also based on robust evidence. Improvement strategies should be implemented to improve the latter.
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Affiliation(s)
- Charlotte Lens
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven—University of Leuven, Leuven, Belgium
| | - Deborah Seys
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven—University of Leuven, Leuven, Belgium
| | - Jelle Demeestere
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven—University of Leuven, Leuven, Belgium
- VIB, Laboratory of Neurobiology, Center for Brain & Disease Research, Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven—University of Leuven, Leuven, Belgium
- VIB, Laboratory of Neurobiology, Center for Brain & Disease Research, Leuven, Belgium
- *Correspondence: Robin Lemmens
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Vanhaecht K, Coeckelberghs E. Interprofessional team working. Implement Sci 2022. [DOI: 10.4324/9781003109945-56] [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: 11/11/2022] Open
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5
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Sermon A, Slock C, Coeckelberghs E, Seys D, Panella M, Bruyneel L, Nijs S, Akiki A, Castillon P, Chipperfield A, El Attal R, Foss NB, Frihagen F, Gerich TG, Gümbel D, Kanakaris N, Kristensen MT, Malchau I, Palm H, Pape HC, Vanhaecht K. Quality indicators in the treatment of geriatric hip fractures: literature review and expert consensus. Arch Osteoporos 2021; 16:152. [PMID: 34625842 DOI: 10.1007/s11657-021-00995-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/23/2021] [Accepted: 08/29/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF). The purpose of this study was to identify quality indicators that assess the quality of in-hospital care for rapid recovery of fragile hip fracture (RR-FHF). METHODS A literature search and guideline selection was conducted to identify recommendations for RR-FHF. Recommendations were categorized as potential structure, process, and outcome QIs and subdivided in-hospital care treatment topics. A list of structure and process recommendations that belongs to care treatment topics relevant for RR-FHF was used to facilitate extraction of recommendations during a 2-day consensus meeting with experts (n = 15) in hip fracture care across Europe. Participants were instructed to select 5 key recommendations relevant for RR-FHF for each part of the in-hospital care pathway: pre-, intra-, and postoperative care. RESULTS In total, 37 potential QIs for RR-FHF were selected based on a methodology using the combination of high levels of evidence and expert opinion. The set consists of 14 process, 13 structure, and 10 outcome indicators that cover the whole perioperative process of fragile hip fracture care. CONCLUSION We suggest the QIs for RR-FHF to be practice tested and adapted to allow for intra-hospital longitudinal follow-up of the quality of care and for inter-hospital and cross-country benchmarking and quality improvement initiatives.
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Affiliation(s)
- An Sermon
- KU Leuven, Leuven, Belgium.,Traumatology Department at University Hospitals Leuven, Leuven, Belgium
| | | | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium.,European Pathway Association, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | - Massimiliano Panella
- European Pathway Association, Leuven, Belgium.,Università Degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | | | - Alain Akiki
- Hôpital Riviera Chablais, Rennaz, Switzerland
| | - Pablo Castillon
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.,Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - Alex Chipperfield
- Consultant Trauma and Orthopaedic Surgeon, East Kent Hospitals NHS Trust, Kent, UK
| | - René El Attal
- Klinik für Orthopädie und Unfallchirurgie, Sporttraumatologie, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Nicolai Bang Foss
- Departments of Anaesthesia and Intensive Care, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frede Frihagen
- Orthopaedic Department, Østfold Hospital Trust, Grålum, Norway.,Associate Professor, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torsten G Gerich
- Head of Orthopaedic Trauma, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.,Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Nikolaos Kanakaris
- Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Morten Tange Kristensen
- Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Palm
- Head of Department, Department of Orthopedics, Copenhagen University Hospital Bispebjerg, Bispebjerg, Denmark
| | - Hans-Christoph Pape
- Department of Trauma, University of Zurich, Universitäts Spital Zurich, Zurich, Switzerland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium. .,European Pathway Association, Leuven, Belgium. .,Department of Quality, University Hospitals Leuven, Leuven, Belgium.
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6
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Seys D, Coeckelberghs E, Sermeus W, Van Zelm R, Panella M, Babu Payedimarri A, Vanhaecht K. Overview on the target population and methods used in care pathway projects: A narrative review. Int J Clin Pract 2021; 75:e14565. [PMID: 34165865 DOI: 10.1111/ijcp.14565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is evidence that the efficiency and effectiveness of care processes can be improved in all countries. Care pathways (CPs) are proposed as a method to improve the quality of care by reducing variation. During the last decades, CPs have been intensively used in practice. The objective of this study is to examine the study designs for investigating CPs, for which pathologies CPs are used and what the reported indicators to measure the impact of CPs are. METHODS A narrative review of the literature published from 2015 to 2019 was performed. RESULTS We identified 286 studies, of which 207 evaluated the impact of CPs, 33 were review articles, 29 studies described the development of a CP, 12 were study protocols and 5 opinion papers. The most frequently reported study design for studying the impact of a CP is pre-posttest (n = 82), followed by cross-sectional studies (n = 50). Oncology, cardiovascular disease and abdominal surgery are the domains with the highest numbers of studies evaluating the impact of CPs. Financial (n = 86), process (n = 76) and clinical indicators (n = 74) are the most frequently reported indicators while service (n = 12) and team indicators (n = 6) are less reported. CONCLUSIONS Based on the relative low number of identified studies compared with the number of CP projects in organisations, we conclude that the CP knowledge is not only found in the literature. We, therefore, argue that (inter)national scientific societies should not only focus on searching and spreading evidence on the content of care but also enhance their knowledge sharing initiatives on the organisation of care processes.
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Affiliation(s)
- Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ruben Van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Anil Babu Payedimarri
- Department of Translational Medicine, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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7
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Plazier M, Raymaekers V, Bruyneel L, Coeckelberghs E, Sermeus W, Vanhaecht K, Duyvendak W. A 15-Year Follow-up Retrospective Study on 959 Spine Surgeries: What Can We Learn From Real-world Data? Clin Spine Surg 2021; 34:E282-E288. [PMID: 33560014 DOI: 10.1097/bsd.0000000000001134] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The aim of this study was to investigate the patient flow and need for additional surgery after first-time lower back surgery. Next, we analyzed the patients who developed chronic low back pain (LBP) and were treated with spinal cord stimulation. SUMMARY OF BACKGROUND DATA LBP has a lifetime prevalence of 84% and imposes a high economic burden. Treatment is focused on preventing chronic pain. Research has shown the efficacy of treatment options. However, less is known about who benefits the most from which therapy and when they should be positioned in the treatment algorithm. METHODS In this retrospective study, data of all patients who underwent first-time surgery from 2000 to 2004 were included. After 10-15 years, patients were contacted about their quality of life (QoL) (EuroQoL-5 Dimension) and life and heath perception (EuroQoL Visual Analogue Scale). RESULTS In all, 959 patients underwent surgery at the lower back area. Follow-up time ranged from 13 to 17 years; 225 patients (23.5%) underwent a second surgery. In total, 20 patients (2.1%) developed chronic neuropathic back pain and received spinal cord stimulation therapy. Ten years postsurgery, 438 (45.7%) patients completed the QoL and LBP questionnaires. The health-related QoL and health situation were significantly lower in patients with multiple surgeries ( P <0.001). CONCLUSIONS The study results indicate that large data sets, with multiple outcome measurements and long-term follow-up are necessary to improve our knowledge and to optimize the therapeutic pathway. In that way, we might learn how to select a patient for the right treatment or treatments at the right moment and shorten the circulation in our health care system.
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Affiliation(s)
- Mark Plazier
- Department of Neurosurgery, Jessa Hospital
- Neurosurgery Study & Training Center Virga Jesse
- Faculty of Medicine and Life Science, Hasselt University, Hasselt
| | | | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Wim Duyvendak
- Department of Neurosurgery, Jessa Hospital
- Neurosurgery Study & Training Center Virga Jesse
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Vanhaecht K, Zeeman G, Schouten L, Bruyneel L, Coeckelberghs E, Panella M, Seys D. Peer support by interprofessional health care providers in aftermath of patient safety incidents: A cross-sectional study. J Nurs Manag 2021; 29:2270-2277. [PMID: 33894076 DOI: 10.1111/jonm.13345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
AIM To investigate the health care professionals' preferences pertaining to support in the aftermath of patient safety incidents and potential variation thereof depending on the degree of harm. BACKGROUND Peer support systems are available to support health care professionals in the aftermath of patient safety incidents. It is unclear which type of support is best offered by whom. METHODS A cross-sectional study in 32 Dutch hospitals. RESULTS In total, 2,362 nurses and 1,404 doctors indicated they were involved in patient safety incidents at any time during their career (86%). Less than 10% of health care providers had spoken with professional support, and less than 20% admitted a need to do so. They used different support. A higher degree of harm related to higher odds of desiring support. Respondents mainly wanted to understand what happened and how it can be prevented. CONCLUSION The desired support of health care professionals in the aftermath of patient safety incidents depends on the level of harm. IMPLICATION FOR NURSING MANAGEMENT Health care professionals seem to mostly rely on persons they are close with, and they mainly desire information related to the aftermath of patient safety incidents. This should be taken into account when support programmes are set up.
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Affiliation(s)
- Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Gerda Zeeman
- Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Loes Schouten
- Coordinator Peer Support Learning, The Randstad, The Netherlands
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont - UPO, Novara, Italy
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Leuven, Belgium
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Coeckelberghs E, Verbeke H, Desomer A, Jonckheer P, Fourney D, Willems P, Coppes M, Rampersaud R, van Hooff M, van den Eede E, Kulik G, de Goumoëns P, Vanhaecht K, Depreitere B. International comparative study of low back pain care pathways and analysis of key interventions. Eur Spine J 2021; 30:1043-1052. [PMID: 33427958 DOI: 10.1007/s00586-020-06675-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. METHODS International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. RESULTS Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. CONCLUSION Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways.
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Affiliation(s)
| | - Hilde Verbeke
- Leuven Center for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Anja Desomer
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - Daryl Fourney
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Paul Willems
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maarten Coppes
- Groningen Spine Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Raja Rampersaud
- Department of Surgery, Division of Orthopaedics, University Health Network Toronto, Toronto, Canada
| | | | | | - Gerit Kulik
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre de Goumoëns
- Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KULeuven, Leuven, Belgium
| | - Bart Depreitere
- Neurosurgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
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10
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. A mixed methods multiple case study to evaluate the implementation of a care pathway for colorectal cancer surgery using extended normalization process theory. BMC Health Serv Res 2021; 21:11. [PMID: 33397382 PMCID: PMC7784254 DOI: 10.1186/s12913-020-06011-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/17/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Specific factors that facilitate or prevent the implementation of enhanced recovery protocols for colorectal cancer surgery have been described in previous qualitative studies. This study aims to perform a concurrent qualitative and quantitative evaluation of factors associated with successful implementation of a care pathway (CP) for patients undergoing surgery for colorectal cancer. METHODS This comparative mixed methods multiple case study was based on a sample of 10 hospitals in 4 European countries that implemented a specific CP and performed pre- and post-implementation measurements. In-depth post-implementation interviews were conducted with healthcare professionals who were directly involved. Primary outcomes included protocol adherence and improvement rate. Secondary outcomes included length of stay (LOS) and self-rated protocol adherence. The hospitals were ranked based on these quantitative findings, and those with the highest and lowest scores were included in this study. Qualitative data were summarized on a per-case basis using extended Normalization Process Theory (eNPT) as theoretical framework. The data were then combined and analyzed using joint display methodology. RESULTS Data from 381 patients and 30 healthcare professionals were included. Mean protocol adherence rate increased from 56 to 62% and mean LOS decreased by 2.1 days. Both measures varied greatly between hospitals. The two highest-ranking hospitals and the three lowest-ranking hospitals were included as cases. Factors which could explain the differences in pre- and post-implementation performance included the degree to which the CP was integrated into daily practice, the level of experience and support for CP methodology provided to the improvement team, the intrinsic motivation of the team, shared goals and the degree of management support, alignment of CP development and hospital strategy, and participation of relevant disciplines, most notably, physicians. CONCLUSIONS Overall improvement was achieved but was highly variable among the 5 hospitals evaluated. Specific factors involved in the implementation process that may be contributing to these differences were conceptualized using eNPT. Multidisciplinary teams intending to implement a CP should invest in shared goals and teamwork and focus on integration of the CP into daily processes. Support from hospital management directed specifically at quality improvement including audit may likewise facilitate the implementation process. TRIAL REGISTRATION NCT02965794 . US National Library of Medicine, ClinicalTrials.gov . Registered 4 August 2014.
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Affiliation(s)
- R van Zelm
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - E Coeckelberghs
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W Sermeus
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Wolthuis
- Depertment of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - L Bruyneel
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - K Vanhaecht
- Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Quality, Academic Policy Advisor, University Hospital Leuven, Leuven, Belgium
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11
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van Zelm R, Coeckelberghs E, Aeyels D, Sermeus W, Wolthuis A, Panella M, Vanhaecht K. Qualitative Evaluation of the Implementation of a Care Pathway for Colorectal Cancer Surgery. Qual Health Res 2021; 31:241-253. [PMID: 33106115 DOI: 10.1177/1049732320965188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Colorectal cancer care can be standardized by using enhanced recovery protocols. However, adherence to these protocols varies. Using Medical Research Council (MRC) guidance on process evaluations, we examined the experience of health care professionals in the implementation of a care pathway for colorectal surgery, by describing the intervention, context, implementation, mechanisms, and outcomes. Based on data from semi-structured interviews, we divided respondents into two groups: those who perceived positive outcomes of the implementation and those who perceived no effect. Respondents who perceived positive outcomes reported clinical leadership, use of feedback, positive effects of standardization, and teamwork as factors contributing to positive perceived outcomes. Respondents who perceived no effect reported a lack of organizational support, as well as challenging collaboration and standardization as mechanisms potentially explaining the poorer perception of outcomes. Multiple implementation activities were used, focusing on competence, behavior, or workplace. Our findings suggest that feedback is an important implementation activity.
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Affiliation(s)
- Ruben van Zelm
- KU Leuven, Leuven, Belgium
- European Pathway Association, Leuven, Belgium
| | | | | | - Walter Sermeus
- KU Leuven, Leuven, Belgium
- European Pathway Association, Leuven, Belgium
| | - Albert Wolthuis
- KU Leuven, Leuven, Belgium
- University Hospital Leuven, Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Leuven, Belgium
- University of Eastern Piemonte, Novarra, Italy
| | - Kris Vanhaecht
- KU Leuven, Leuven, Belgium
- European Pathway Association, Leuven, Belgium
- University Hospital Leuven, Leuven, Belgium
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12
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Vanhaecht K, Van Bael E, Coeckelberghs E, Van der Auwera C, Claessens F, Bruyneel L, De Ridder D, Panella M, Bisognano M, Delgado PL, Seys D. Mangomoments - preconditions and impact on patients and families, healthcare professionals and organisations: a multi-method study in Flemish hospitals. BMJ Open 2020; 10:e034543. [PMID: 32764082 PMCID: PMC7412612 DOI: 10.1136/bmjopen-2019-034543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Understanding how small unexpected acts or gestures by healthcare professionals, known as Mangomoments, are translated into practice, what their preconditions are and what their impact is on patients and families, healthcare professionals and organisations. DESIGN A multi-method design was used based on four phases: (1) A (media)campaign to collect Mangomoment stories (n=1045), of which 94% (n=983) were defined as Mangomoments; (2) Semi-structured interviews (n=120); (3) Focus group interviews (n=3); and (4) A consensus meeting. SETTING Respondents from a hospital and primary care setting. PARTICIPANTS Patients, family, healthcare professionals, managers, researchers and a policymaker participated. RESULTS Mangomoments are mainly classified in the dimensions 'Respect for values, preferences and needs' and 'Emotional support'. Differences in importance of the dimensions were found between healthcare professionals, oncological patients and family and non-oncological patients and family. The results of the interviews, focus groups and consensus meeting were visualised by the Mangomoment model. It identifies several preconditions on the level of patients, healthcare professionals and leadership. For each of these preconditions a catalyst was identified to increase the prevalence of Mangomoments. In general, Mangomoments improved the patient and family experience and facilitated adherence to therapy and led to a positive perception on the healing process. Positive effects for professionals include personal accomplishment and anti-burnout, joy in work and a positive team atmosphere. This led to positive resonance by a relationship of trust between the patient and the healthcare professionals, feelings of tolerance during negative experiences and open communication and a safe climate. Overall, patients and healthcare workers concluded that Mangomoments led to loyalty to the healthcare organisation. CONCLUSION Mangomoments do not only have a positive impact on patient and family but also on the healthcare professional. Leadership should shape several preconditions and catalysts which can lead to positive resonance and loyalty of patients and professionals.
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Affiliation(s)
- Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Elly Van Bael
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Critical Care, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Medical Department, Jessa Ziekenhuis, Hasselt, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | | | - Pedro L Delgado
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Deborah Seys
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Flemish Institute for Quality of Care, Brussels, Belgium
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13
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre-post-test study. Updates Surg 2020; 72:61-71. [PMID: 31993994 DOI: 10.1007/s13304-020-00706-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 01/28/2023]
Abstract
Adherence to evidence-based recommendations is variable and generally low. This is also followed in colorectal surgery, despite the availability of the ERAS® protocol. The aim of the study was to evaluate the effect of implementing a care pathway for perioperative care in colorectal cancer surgery on outcomes and protocol adherence. So, we performed an international pre-test-post-test multicenter study, performed in ten hospitals in four European countries. The measures used included length of stay, morbidity and mortality, and documentation and adherence on intervention and patient level. Unadjusted pre-test-post-test differences were analyzed following an analysis adjusted for patient-mix variables. Importance-performance analysis was used to map the relationship between importance and performance of individual interventions. In total, 381 patients were included. Length of stay decreased from 12.6 to 10.7 days (p = 0.0230). Time to normal diet and walking also decreased significantly. Protocol adherence improved from 56 to 62% (p < 0.00001). Adherence to individual interventions remained highly variable. Importance-performance analysis showed 30 interventions were scored as important, of which 19 had an adherence < 70%, showing priorities for improvement. Across hospitals, change in protocol adherence ranged from a 13% decrease to a 22% increase. Implementing a care pathway for colorectal cancer surgery reduced length of stay, time to normal diet and walking. Documentation and protocol adherence improved after implementing the care pathway. However, not in all participating hospitals protocol adherence improved. Only in 25% of patients, protocol adherence of ≥ 70% was achieved, suggesting a large group is at risk for underuse. Importance-performance analysis showed which interventions are important, but have low adherence, prioritizing improvement efforts.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium. .,European Pathway Association, Louvain, Belgium.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Louvain, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,University Hospitals Leuven, Louvain, Belgium
| | - Massimiliano Panella
- European Pathway Association, Louvain, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium.,Department of Quality, University Hospital Leuven, Louvain, Belgium
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14
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Depreitere B, Jonckheer P, Coeckelberghs E, Desomer A, van Wambeke P. The pivotal role for the multidisciplinary approach at all phases and at all levels in the national pathway for the management of low back pain and radicular pain in Belgium. Eur J Phys Rehabil Med 2019; 56:228-236. [PMID: 31556511 DOI: 10.23736/s1973-9087.19.05984-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION High level evidence on management of spinal disorders is scarce, which results in guidelines being of limited practical use for practitioners. Care pathways are complex interventions intended for the mutual decision making of organization of care processes for a well-defined group of patients. The goal of this project was to design a pathway for the management of low back pain and radicular pain for national implementation in Belgium. EVIDENCE ACQUISITION An international and Belgian study on characteristics of low back pain care pathways was performed along with a literature study and focus group interrogation. Based on essential building elements identified and a consensus approach among all relevant stakeholders in primary, hospital and reintegration care, a national pathway was constructed. The process was endorsed by the Belgian Health Care Knowledge Center, Belgian National Institute of Health and Disability Insurance and the Spine Society of Belgium. EVIDENCE SYNTHESIS Eleven international pathways were identified, varying in implementation width from hospital-based to region/province-based. Seven Belgian pathway initiatives were detected. Notwithstanding differences, consistent building elements were identified. Three groups of caregivers, divided in primary care, hospital care and reintegration and including all relevant medical/paramedical disciplines, worked on integrating the essential building elements into a single concrete patient pathway of direct use to any caregiver and patient and based on a consensus model including reference to the 2017 Belgian adaptation of the 2016 NICE guidelines. The resulting pathways on management of low back pain and radicular pain underpin the importance of multidisciplinary teamwork. CONCLUSIONS Essential building elements were identified from literature and established pathways and were successfully integrated in a Belgian national low back pain and radicular pain pathway using an integrative consensus approach. The pathways are consultable at www.lowbackpain.kce.be.
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Affiliation(s)
- Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium -
| | | | - Ellen Coeckelberghs
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Anja Desomer
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Peter van Wambeke
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
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15
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Diaz M, Avila A, Degens H, Coeckelberghs E, Vanhees L, Cornelissen V, Azzawi M. Acute resveratrol supplementation in coronary artery disease: towards patient stratification. SCAND CARDIOVASC J 2019; 54:14-19. [PMID: 31429599 DOI: 10.1080/14017431.2019.1657584] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 10/26/2022]
Abstract
Objective: Resveratrol (RV) is a polyphenol with antioxidant, anti-inflammatory and cardio-protective properties. Our objective was to investigate whether acute supplementation with high doses of RV would improve flow-mediated dilation (FMD) and oxygen consumption (VO2) kinetics in older coronary artery disease (CAD) patients. Design: We employed a placebo-controlled, single-blind, crossover design in which ten participants (aged 66.6 ± 7.8 years) received either RV or placebo (330 mg, 3× day-1) during three consecutive days plus additional 330 mg in the morning of the fourth day with a seven-day wash-out period in-between. On the fourth day, FMD of the brachial artery and VO2 on-kinetics were determined. Results: RV improved FMD in patients who had undergone coronary artery bypass grafting (CABG; -1.4 vs. 5.0%; p = .004), but not in those who had undergone percutaneous coronary intervention (PCI; 4.2 vs. -0.2%; NS). Conclusion: Acute high dose supplementation with RV improved FMD in patients after CABG surgery but impaired FMD in patients who underwent PCI. The revascularization method-related differential effects of RV may be due to its direct effects on endothelial-dependent dilator responses. Our findings have important implications for personalized treatment and stratification of older CAD patients.
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Affiliation(s)
- M Diaz
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.,Swedish Red Cross University College, Huddinge, Sweden
| | - A Avila
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.,Research Group for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - H Degens
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - E Coeckelberghs
- Research Group for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - L Vanhees
- Research Group for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - V Cornelissen
- Research Group for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - M Azzawi
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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16
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Zeeman G, Schouten L, Seys D, Coeckelberghs E, Weijenborg P, Bruyneel L, Vanhaecht K. Prolonged mental health sequelae among doctors and nurses involved in patient safety incidents with formal complaints and lawsuits. Eur J Public Health 2019; 30:777-779. [DOI: 10.1093/eurpub/ckz138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
We evaluated the presence of prolonged mental health sequelae in the aftermath of a patient safety incident and the impact of a formal complaint or lawsuit on these mental health sequelae in 19 hospitals and 2635 nurses and doctors. Of 2635 respondents, 983 (37.3%) reported a complaint and 190 (7.2%) reported a lawsuit. In both doctors and nurses prolonged mental health sequelae reflecting a stressor-related disorder were highly prevalent, each well over 20% overall. They were consistently more prevalent in case of a formal complaint or lawsuit. Lawsuits showed 2-, 3- and 4-fold increases in prevalence of mental health sequelae.
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Affiliation(s)
- Gerda Zeeman
- Department of Gynecology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | | | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven––University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven––University of Leuven, Leuven, Belgium
| | - Philomeen Weijenborg
- Department of Gynecology, University Medical Center Leiden, Leiden, The Netherlands
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven––University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven––University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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17
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Vanhaecht K, Seys D, Schouten L, Bruyneel L, Coeckelberghs E, Panella M, Zeeman G. Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm: a cross-sectional study in the Netherlands. BMJ Open 2019; 9:e029923. [PMID: 31292185 PMCID: PMC6624045 DOI: 10.1136/bmjopen-2019-029923] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To describe healthcare providers' symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the incident. DESIGN Cross-sectional survey. SETTING 32 Dutch hospitals that participate in the 'Peer Support Collaborative'. PARTICIPANTS 4369 healthcare providers (1619 doctors and 2750 nurses) involved in a PSI at any time during their career. INTERVENTIONS All doctors and nurses working in direct patient care in the 32 participating hospitals were invited via email to participate in an online survey. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of symptoms, symptom duration and its relationship with the degree of patient harm. RESULTS In total 4369 respondents were involved in a PSI and completely filled in the questionnaire. Of these, 462 reported having been involved in a PSI with permanent harm or death during the last 6 months. This had a personal, professional impact as well as impact on effective teamwork requirements. The impact of a PSI increased when the degree of patient harm was more severe. The most common symptom was hypervigilance (53.0%). The three most common symptoms related to teamwork were having doubts about knowledge and skill (27.0%), feeling unable to provide quality care (15.6%) and feeling uncomfortable within the team (15.5%). PSI with permanent harm or death was related to eightfold higher likelihood of provider-related symptoms lasting for more than 1 month and ninefold lasting longer than 6 months compared with symptoms reported when the PSI caused no harm. CONCLUSION The impact of PSI remains an underestimated problem. The higher the degree of harm, the longer the symptoms last. Future studies should evaluate how these data can be integrated in evidence-based support systems.
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Affiliation(s)
- Kris Vanhaecht
- Leuven Institute for Healthcare Policy – Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy – Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Loes Schouten
- Management Consultant & coordinator Peer Support Learning Network, Utrecht, The Netherlands
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy – Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy – Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piedmont - UPO, Novara, Italy
| | - Gerda Zeeman
- Tjongerschans Hospital, Heerenveen, The Netherlands
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18
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Seys D, Panella M, VanZelm R, Sermeus W, Aeyels D, Bruyneel L, Coeckelberghs E, Vanhaecht K. Care pathways are complex interventions in complex systems: New European Pathway Association framework. International Journal of Care Coordination 2019. [DOI: 10.1177/2053434519839195] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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
Care pathway implementation is characterised by a dual complexity. A care pathway itself represents a complex intervention with multiple interacting and interdependent intervention components and outcomes. The organisations in which care pathways are being implemented represent complex systems that need to be directed at change through an in-depth understanding of their external and internal context in which they are functioning in. This study sets out a new evidence-based and pragmatic framework that unpacks how intervention mechanisms, intervention fidelity and care context are converge and represent interacting processes that determine success or failure of the care pathway. We recommend researchers looking to increase the effectiveness of care pathway implementation and accelerate improvement of desired outcomes to adopt this framework from inception to implementation of the intervention.
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Affiliation(s)
- D Seys
- KU Leuven – University of Leuven, Belgium
| | - M Panella
- KU Leuven – University of Leuven, Belgium
- University of Eastern Piedmont ‘A. Avogadro’, Italy
| | - R VanZelm
- KU Leuven – University of Leuven, Belgium
| | - W Sermeus
- KU Leuven – University of Leuven, Belgium
| | - D Aeyels
- Universitair Ziekenhuis Brussel, Belgium
| | - L Bruyneel
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
| | | | - K Vanhaecht
- KU Leuven – University of Leuven, Belgium
- University Hospitals Leuven, Belgium
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19
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Van Zelm R, Coeckelberghs E, Sermeus W, Panella M, Wolthuis A, Vanhaecht K. Variation in perioperative nutrition in colorectal cancer patients – first results of an international quality improvement study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1984] [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]
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20
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Bruyneel L, Van Houdt S, Coeckelberghs E, Sermeus W, Tambuyzer E, Cosemans P, Peeters G, Van den Broeck K, Weeghmans I, Vanhaecht K. Patient experiences with care across various types of mental health care: Questionnaire development, measurement invariance, and patients' reports. Int J Methods Psychiatr Res 2018; 27:e1592. [PMID: 29027313 PMCID: PMC6877140 DOI: 10.1002/mpr.1592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/21/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 11/12/2022] Open
Abstract
To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty-five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after-care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168). Exploratory structural equation modelling was conducted on a random split-half sample to examine dimensionality. Confirmatory factor analysis and multiple group confirmatory factor analyses were conducted on the holdout sample to confirm dimensionality and assess measurement invariance across type of service and patient characteristics. Multilevel logistic regression models linking subscale top box scores to overall rating items were used to assess criterion validity. The hypothesized dimensionality was partly confirmed, and configural and scalar invariance were demonstrated across types of organizations and patient characteristics. Subscale scores were significantly associated with overall ratings. Process evaluation showed that participating organizations strongly support continued use of this questionnaire. This validated patient experience questionnaire supports comparison across organizations from different types of services to improve the quality of mental health care.
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Affiliation(s)
- Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Sabine Van Houdt
- Flemish Patient Platform, Heverlee, Belgium.,Academic Centre for General Practice, University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | | | | | | | - Kris Van den Broeck
- Flemish Association for Psychiatry, Kortenberg, Belgium.,Flemish Agency for Care and Health, Brussels, Belgium
| | | | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
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van Zelm R, Janssen I, Vanhaecht K, de Buck van Overstraeten A, Panella M, Sermeus W, Coeckelberghs E. Development of a model care pathway for adults undergoing colorectal cancer surgery: Evidence-based key interventions and indicators. J Eval Clin Pract 2018; 24:232-239. [PMID: 28145019 DOI: 10.1111/jep.12700] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES During the last decades, perioperative care for patients with colorectal cancer has shifted towards more standardized care, so-called "enhanced recovery after surgery." Those programs aim to optimize interventions in perioperative care to decrease the rate of postoperative complications, improve patients' recovery, and shorten hospital stay. The purpose of this literature review is to identify, summarize, and operationalize the clinical content of both key interventions and clinical indicators to develop an evidence-based model pathway for surgical patients with colorectal cancer. METHODS A systematic search in 3 databases was conducted to identify key interventions (KIs) and indicators to measure the effect of implementation of care pathways. The KIs from the enhanced recovery after surgery protocol were listed and used as framework to identify and match KIs used in the included studies. The Clinical Pathway Compass was used to categorize the indicators. RESULTS Fifteen studies were included. The number of KI used in the study protocols ranged from 9 to 20. In total, 33 KIs were identified. Little information was available concerning the implementation of and compliance to the protocol. Length of stay and complication rate are the most common used indicators (used in 15/15 and 14/15 of the studies), followed by 21 other measures. All but one of the included studies reported a reduction in length of stay. CONCLUSION There is a considerable variation in both number of KIs and indicators as well as operationalization of key interventions, for surgical patients with colorectal cancer documented in literature. Therefore, we summarized the input from different studies and developed an evidence-based model pathway, which can serve as a basis for a local/regional care pathway team to build their own pathway.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,Q-Consult, Utrecht, the Netherlands
| | | | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,University Hospital Leuven, Leuven, Belgium
| | | | - Massimiliano Panella
- Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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22
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Aeyels D, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Sermeus W, Panella M, Coeckelberghs E, Bruyneel L, Vanhaecht K. Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey. Acta Cardiol 2017; 73:1-10. [PMID: 29237337 DOI: 10.1080/00015385.2017.1411664] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. METHODS AND RESULTS A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. CONCLUSIONS A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.
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Affiliation(s)
- Daan Aeyels
- a Leuven Institute for Healthcare Policy , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Peter R Sinnaeve
- b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Marc J Claeys
- c Department of Cardiology , Antwerp University Hospital , Edegem , Belgium
| | - Sofie Gevaert
- d Department of Cardiology , Ghent University Hospital , Ghent , Belgium
| | - Danny Schoors
- e Department of Cardiology , University Hospitals Brussels , Brussels , Belgium
| | - Walter Sermeus
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- g Department of Clinical and Experimental Medicine , Amedeo Avogadro University of Eastern Piedmont , Vercelli , Italy
| | | | - Luk Bruyneel
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Kris Vanhaecht
- h Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
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23
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van Zelm R, Coeckelberghs E, Sermeus W, De Buck van Overstraeten A, Weimann A, Seys D, Panella M, Vanhaecht K. Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals. Int J Colorectal Dis 2017; 32:1471-1478. [PMID: 28717841 DOI: 10.1007/s00384-017-2863-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in practice. This study was designed to assess the adherence rate in daily practice and examine the relationship between the importance of interventions and adherence rate. METHODS This international observational, cross-sectional multicenter study was performed in 12 hospitals in four European countries. Patients were included from January 1, 2014. Data was retrospectively collected from the patient record by the local study coordinator. RESULTS A total of 230 patients were included in the study. Protocol adherence was analyzed for both the individual interventions and on patient level. The interventions with the highest adherence were antibiotic prophylaxis (95%), thromboprophylaxis (87%), and measuring body weight at admission (87%). Interventions with the lowest adherence were early mobilization-walking and sitting (9 and 6%, respectively). The adherence ranged between 16 and 75%, with an average of 44%. CONCLUSION Our results show that the average protocol adherence in clinical practice is 44%. The variation on patient and hospital level is considerable. Only in one patient the adherence rate was >70%. In total, 30% of patients received 50% or more of the key interventions. A solid implementation strategy seems to be needed to improve the uptake of the ERAS pathway. The importance-performance matrix can help in prioritizing the areas for improvement.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium. .,European Pathway Association, Leuven, Belgium. .,Q-Consult zorg, Utrecht, The Netherlands.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium
| | | | - Arved Weimann
- Department of General, Abdominal, and Oncological Surgery, Klinikum Skt George, Leipzig, Germany
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novara, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,European Pathway Association, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Pattyn N, Beckers PJ, Cornelissen VA, Coeckelberghs E, De Maeyer C, Frederix G, Goetschalckx K, Possemiers N, Schepers D, Van Craenenbroeck EM, Wuyts K, Conraads VM, Vanhees L. The effect of aerobic interval training and continuous training on exercise capacity and its determinants. Acta Cardiol 2017. [PMID: 28636505 DOI: 10.1080/00015385.2017.1304712] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective We aimed to investigate (1) the effects of aerobic interval training (AIT) and aerobic continuous training (ACT) on (sub)maximal exercise measures and its determinants including endothelial function, muscle strength and cardiac autonomic function, and (2) the relationship between exercise capacity and these determinants. Methods Two-hundred coronary artery disease (CAD) patients (58.4 ± 9.1 years) were randomized to AIT or ACT for 12 weeks. All patients performed a cardiopulmonary exercise test and endothelial function measurements before and after the intervention; a subpopulation underwent muscle strength and heart rate variability (HRV) assessments. Results The VO2, heart rate and workload at peak and at first and second ventilatory threshold increased (P-time <0.001); the oxygen uptake efficiency slope (P-time <0.001) and half time of peak VO2 (P-time <0.001) improved. Endothelial function and heart rate recovery (HRR) at 1 and 2 min improved (P-time <0.001), while measures of muscle strength and HRV did not change. Both interventions were equally effective. Significant correlations were found between baseline peak VO2 and (1) quadriceps strength (r = 0.44; P < 0.001); (2) HRR at 2 min (r = 0.46; P < 0.001). Changes in peak VO2 correlated significantly with changes in (1) FMD (ρ = 0.17; P < 0.05); (2) quadriceps strength (r = 0.23; P < 0.05); (3) HRR at 2 min (ρ = 0.18; P < 0.05) and Total power of HRV (ρ = 0.41; P < 0.05). Conclusions This multicentre trial shows equal improvements in maximal and submaximal exercise capacity, endothelial function and HRR after AIT and ACT, while these training methods seem to be insufficient to improve muscle strength and HRV. Changes in peak VO2 were linked to changes in all underlying parameters.
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Affiliation(s)
- Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Paul J. Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Antwerp, Belgium
| | | | | | - Catherine De Maeyer
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Antwerp, Belgium
| | - Geert Frederix
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - Nadine Possemiers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Dirk Schepers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | | | - Kurt Wuyts
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Viviane M. Conraads
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Antwerp, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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25
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Buys R, Coeckelberghs E, Cornelissen VA, Goetschalckx K, Vanhees L. Prognostic value of the post-training oxygen uptake efficiency slope in patients with coronary artery disease. Eur J Prev Cardiol 2016; 23:1363-71. [PMID: 27099396 DOI: 10.1177/2047487316643446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/30/2015] [Accepted: 03/17/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Peak oxygen uptake is an independent predictor of mortality in patients with coronary artery disease (CAD). However, patients with CAD are not always capable of reaching peak effort, and therefore submaximal gas exchange variables such as the oxygen uptake efficiency slope (OUES) have been introduced. Baseline exercise capacity as expressed by OUES provides prognostic information and this parameter responds to training. Therefore, we aimed to assess the prognostic value of post-training OUES in patients with CAD. METHODS We included 960 patients with CAD (age 60.6 ± 9.5 years; 853 males) who completed a cardiac rehabilitation program between 2000 and 2011. The OUES was calculated before and after cardiac rehabilitation and information on mortality was obtained. The relationships of post-training OUES with all-cause and cardiovascular (CV) mortality was assessed by Cox proportional hazards regression analyses. Receiver operator characteristic curve analysis was performed in order to obtain the optimal cut-off value. RESULTS During 7.37 ± 3.20 years of follow-up (range: 0.45-13.75 years), 108 patients died, among whom 47 died due to CV reasons. The post-training OUES was related to all-cause (hazard ratio: 0.50, p < 0.001) and CV (hazard ratio: 0.40, p < 0.001) mortality. When significant covariates, including baseline OUES, were entered into the Cox regression analysis, post-training OUES remained related to all-cause and CV mortality (hazard ratio: 0.40, p < 0.01 and 0.26, p < 0.01, respectively). In addition, the change in OUES due to exercise training was positively related to mortality (hazard ratio: 0.49, p < 0.01). CONCLUSION Post-training OUES has stronger prognostic value compared to baseline OUES. The lack of improvement in exercise capacity expressed by OUES after an exercise training program relates to a worse prognosis and can help distinguish patients with favorable and unfavorable prognoses.
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Affiliation(s)
- Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, University Hospitals of Leuven, Leuven, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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26
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van Assche T, Buys R, de Jaeger M, Coeckelberghs E, Cornelissen VA. One single bout of low-intensity isometric handgrip exercise reduces blood pressure in healthy pre- and hypertensive individuals. J Sports Med Phys Fitness 2016; 57:469-475. [PMID: 27029960 DOI: 10.23736/s0022-4707.16.06239-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the acute effect of one single session of isometric handgrip exercise (IHG) on blood pressure (BP) during daily life activities in healthy adults. METHODS Fifteen healthy adults with pre- or stage 1 hypertension (10 men; mean age 48±7.1 years) completed two experimental sessions in random order: one control (rest for 15 minutes) and one low intensity IHG session (4×2 minutes sustained contractions at 30% of maximal volutional contraction interspersed with 1-minute rest intervals). Blood pressure was recorded before each intervention and following the intervention BP was recorded for one hour in the office and thereafter for 6 hours during their daily activities by means of an ambulatory BP device. Physical activity (number of steps and total energy expenditure) was assessed by means of a SenseWear mini device. RESULTS Systolic BP was higher the first minute after the isometric handgrip exercise but quickly returned to baseline levels after 15 minutes in the office. Over the 7-hour period, systolic blood pressure was significantly lower (-5.4±7.3 vs. +0.23±6.9; P<0.05) after IHG compared to the control session. Although not significant, a tendency was observed towards a lower diastolic blood pressure after IHG compared to control (P=0.09). Physical activity behavior was similar on both days (P>0.05). CONCLUSIONS This study demonstrates that one single bout of IHG can result in an overall reduction in BP during daily activities. More research is needed to confirm these findings and to explain possible mechanisms responsible for these observed changes.
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Affiliation(s)
- Tim van Assche
- Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Mats de Jaeger
- Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
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27
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Beckers P, Vanhees L, Pattyn N, De Maeyer C, Coeckelberghs E, Frederix G, Goetschalckx K, Van Craenenbroeck E, Cornelissen V, Conraads V. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the saintex-cad study. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.278] [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: 11/24/2022]
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28
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Coeckelberghs E, Buys R, Goetschalckx K, Cornelissen VA, Vanhees L. Prognostic value of the oxygen uptake efficiency slope and other exercise variables in patients with coronary artery disease. Eur J Prev Cardiol 2015; 23:237-44. [DOI: 10.1177/2047487315569410] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Ellen Coeckelberghs
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Véronique A Cornelissen
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
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Pattyn N, Coeckelberghs E, Buys R, Cornelissen VA, Vanhees L. Aerobic interval training vs. moderate continuous training in coronary artery disease patients: a systematic review and meta-analysis. Sports Med 2014; 44:687-700. [PMID: 24549476 DOI: 10.1007/s40279-014-0158-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exercise training improves exercise capacity (peakVO2), which is closely related to long-term survival in cardiac patients. However, it remains unclear which type and intensity of exercise is most effective for improving exercise tolerance and body weight. Individual studies suggest that aerobic interval training (AIT) might increase peakVO2 more in this population. OBJECTIVE We conducted a meta-analysis to summarize the effects of AIT compared with moderate continuous training (MCT) on peakVO2, submaximal exercise capacity, and body weight in patients with coronary artery disease (CAD) with preserved and/or reduced left ventricular ejection fraction (LVEF). DATA SOURCES AND STUDY SELECTION A systematic search was conducted and we included randomized trials comparing AIT and MCT in CAD patients lasting at least 4 weeks, reporting peakVO2 results, and published in a peer-reviewed journal up to May 2013. The primary outcome measure was peakVO2. Secondary outcomes were submaximal exercise capacity parameters and body weight. SYNTHESIS METHODS Random- and fixed-effects models were used and data were reported as weighted means and 95% confidence intervals (CIs). RESULTS Nine study groups were included, involving 206 patients (100 AIT, 106 MCT). Overall, AIT resulted in a significantly larger increase in peakVO2 [+1.60 mL/kg/min (95% CI 0.18-3.02; p = 0.03)] compared with MCT. MCT seemed to be more effective in reducing body weight (-0.78 kg; 95% CI -0.01 to 1.58; p = 0.05). LIMITATIONS The small number of studies might have affected the power to reach significance for the secondary outcomes. CONCLUSION In CAD patients with preserved and/or reduced LVEF, AIT is superior to MCT for improving peakVO2, while MCT seems to be more effective in reducing body weight. However, large, well-designed, randomized controlled trials are warranted to confirm these findings.
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Affiliation(s)
- Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Tervuursevest 101, B 1501, 3001, Heverlee, Belgium,
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30
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Conraads VM, Pattyn N, De Maeyer C, Beckers PJ, Coeckelberghs E, Cornelissen VA, Denollet J, Frederix G, Goetschalckx K, Hoymans VY, Possemiers N, Schepers D, Shivalkar B, Voigt JU, Van Craenenbroeck EM, Vanhees L. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. Int J Cardiol 2014; 179:203-10. [PMID: 25464446 DOI: 10.1016/j.ijcard.2014.10.155] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/22/2014] [Accepted: 10/24/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation increases peak oxygen uptake (peak VO₂), which is an important predictor of mortality in cardiac patients. However, it remains unclear which exercise characteristics are most effective for improving peak VO₂ in coronary artery disease (CAD) patients. Proof of concept papers comparing Aerobic Interval Training (AIT) and Moderate Continuous Training (MCT) were conducted in small sample sizes and findings were inconsistent and heterogeneous. Therefore, we aimed to compare the effects of AIT and Aerobic Continuous Training (ACT) on peak VO₂, peripheral endothelial function, cardiovascular risk factors, quality of life and safety, in a large multicentre study. METHODS Two-hundred CAD patients (LVEF >40%, 90% men, mean age 58.4 ± 9.1 years) were randomized to a supervised 12-week cardiac rehabilitation programme of three weekly sessions of either AIT (90-95% of peak heart rate (HR)) or ACT (70-75% of peak HR) on a bicycle. Primary outcome was peak VO₂; secondary outcomes were peripheral endothelial function, cardiovascular risk factors, quality of life and safety. RESULTS Peak VO₂ (ml/kg/min) increased significantly in both groups (AIT 22.7 ± 17.6% versus ACT 20.3 ± 15.3%; p-time<0.001). In addition, flow-mediated dilation (AIT+34.1% (range -69.8 to 646%) versus ACT+7.14% (range -66.7 to 503%); p-time<0.001) quality of life and some other cardiovascular risk factors including resting diastolic blood pressure and HDL-C improved significantly after training. Improvements were equal for both training interventions. CONCLUSIONS Contrary to earlier smaller trials, we observed similar improvements in exercise capacity and peripheral endothelial function following AIT and ACT in a large population of CAD patients.
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Affiliation(s)
- Viviane M Conraads
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Antwerp, Belgium
| | - Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Catherine De Maeyer
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Antwerp, Belgium.
| | - Paul J Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Antwerp, Belgium.
| | | | | | - Johan Denollet
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; CoRPS-Centre of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
| | - Geert Frederix
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium.
| | - Kaatje Goetschalckx
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals of Leuven, Leuven, Belgium.
| | - Vicky Y Hoymans
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Antwerp, Belgium; Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium.
| | - Nadine Possemiers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
| | - Dirk Schepers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Bharati Shivalkar
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Antwerp, Belgium.
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals of Leuven, Leuven, Belgium.
| | - Emeline M Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Antwerp, Belgium; Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium.
| | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals of Leuven, Leuven, Belgium.
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Buys R, Coeckelberghs E, Vanhees L, Cornelissen VA. The oxygen uptake efficiency slope in 1411 Caucasian healthy men and women aged 20–60 years: reference values. Eur J Prev Cardiol 2014; 22:356-63. [DOI: 10.1177/2047487314547658] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | | | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven, Belgium
- Research Group Lifestyle and Health, Faculty of Health Care, UAS, Utrecht, The Netherlands
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32
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Conraads VM, Van Craenenbroeck EM, Pattyn N, Cornelissen VA, Beckers PJ, Coeckelberghs E, De Maeyer C, Denollet J, Frederix G, Goetschalckx K, Hoymans VY, Possemiers N, Schepers D, Shivalkar B, Vanhees L. Rationale and design of a randomized trial on the effectiveness of aerobic interval training in patients with coronary artery disease: The SAINTEX-CAD study. Int J Cardiol 2013; 168:3532-6. [DOI: 10.1016/j.ijcard.2013.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/20/2013] [Accepted: 05/03/2013] [Indexed: 11/29/2022]
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Coeckelberghs E, Pattyn N, Buys R, Cornelissen VA, Vanhees L. Interval versus continuous exercise training in coronary artery disease: a meta-analysis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Buys R, Cornelissen V, Van De Bruaene A, Stevens A, Coeckelberghs E, Onkelinx S, Thomaes T, Delecluse C, Budts W, Vanhees L. Measures of exercise capacity in adults with congenital heart disease. Int J Cardiol 2011; 153:26-30. [PMID: 20840883 DOI: 10.1016/j.ijcard.2010.08.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/01/2010] [Accepted: 08/07/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Roselien Buys
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101 bus 1501, 3001 Heverlee, Belgium
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Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension 2011. [PMID: 21896934 DOI: 10.1161/hypertension.aha.111.177071] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
We reviewed the effect of resistance training on blood pressure and other cardiovascular risk factors in adults. Randomized, controlled trials lasting ≥4 weeks investigating the effects of resistance training on blood pressure in healthy adults (age ≥18 years) and published in a peer-reviewed journal up to June 2010 were included. Random- and fixed-effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 28 randomized, controlled trials, involving 33 study groups and 1012 participants. Overall, resistance training induced a significant blood pressure reduction in 28 normotensive or prehypertensive study groups [-3.9 (-6.4; -1.2)/-3.9 (-5.6; -2.2) mm Hg], whereas the reduction [-4.1 (-0.63; +1.4)/-1.5 (-3.4; +0.40) mm Hg] was not significant for the 5 hypertensive study groups. When study groups were divided according to the mode of training, isometric handgrip training in 3 groups resulted in a larger decrease in blood pressure [-13.5 (-16.5; -10.5)/-6.1(-8.3; -3.9) mm Hg] than dynamic resistance training in 30 groups [-2.8 (-4.3; -1.3)/-2.7 (-3.8; -1.7) mm Hg]. After dynamic resistance training, Vo(2) peak increased by 10.6% (P=0.01), whereas body fat and plasma triglycerides decreased by 0.6% (P<0.01) and 0.11 mmol/L (P<0.05), respectively. No significant effect could be observed on other blood lipids and fasting blood glucose. This meta-analysis supports the blood pressure-lowering potential of dynamic resistance training and isometric handgrip training. In addition, dynamic resistance training also favorably affects some other cardiovascular risk factors. Our results further suggest that isometric handgrip training may be more effective for reducing blood pressure than dynamic resistance training. However, given the small amount of isometric studies available, additional studies are warranted to confirm this finding.
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Affiliation(s)
- Véronique A Cornelissen
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium.
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Abstract
We reviewed the effect of resistance training on blood pressure and other cardiovascular risk factors in adults. Randomized, controlled trials lasting ≥4 weeks investigating the effects of resistance training on blood pressure in healthy adults (age ≥18 years) and published in a peer-reviewed journal up to June 2010 were included. Random- and fixed-effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 28 randomized, controlled trials, involving 33 study groups and 1012 participants. Overall, resistance training induced a significant blood pressure reduction in 28 normotensive or prehypertensive study groups [−3.9 (−6.4; −1.2)/−3.9 (−5.6; −2.2) mm Hg], whereas the reduction [−4.1 (−0.63; +1.4)/−1.5 (−3.4; +0.40) mm Hg] was not significant for the 5 hypertensive study groups. When study groups were divided according to the mode of training, isometric handgrip training in 3 groups resulted in a larger decrease in blood pressure [−13.5 (−16.5; −10.5)/−6.1(−8.3; −3.9) mm Hg] than dynamic resistance training in 30 groups [−2.8 (−4.3; −1.3)/−2.7 (−3.8; −1.7) mm Hg]. After dynamic resistance training, V
o
2
peak increased by 10.6% (
P
=0.01), whereas body fat and plasma triglycerides decreased by 0.6% (
P
<0.01) and 0.11 mmol/L (
P
<0.05), respectively. No significant effect could be observed on other blood lipids and fasting blood glucose. This meta-analysis supports the blood pressure–lowering potential of dynamic resistance training and isometric handgrip training. In addition, dynamic resistance training also favorably affects some other cardiovascular risk factors. Our results further suggest that isometric handgrip training may be more effective for reducing blood pressure than dynamic resistance training. However, given the small amount of isometric studies available, additional studies are warranted to confirm this finding.
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Affiliation(s)
- Véronique A. Cornelissen
- From the Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences (V.A.C., E.C., L.V.) and the Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, Faculty of Medicine (R.H.F.), K.U. Leuven, Leuven, Belgium
| | - Robert H. Fagard
- From the Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences (V.A.C., E.C., L.V.) and the Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, Faculty of Medicine (R.H.F.), K.U. Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- From the Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences (V.A.C., E.C., L.V.) and the Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, Faculty of Medicine (R.H.F.), K.U. Leuven, Leuven, Belgium
| | - Luc Vanhees
- From the Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences (V.A.C., E.C., L.V.) and the Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, Faculty of Medicine (R.H.F.), K.U. Leuven, Leuven, Belgium
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Onkelinx S, Cornelissen V, Defoor J, Matthijs G, Thomaes T, Coeckelberghs E, Buys R, Schepers D, Fagard R, Vanhees L. The CAREGENE study: genetic variants of the endothelium and aerobic power in patients with coronary artery disease. Acta Cardiol 2011; 66:407-14. [PMID: 21894794 DOI: 10.1080/ac.66.4.2126586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Aerobic phenotypes show a wide variability to similar aerobic training stimuli, which can be partly attributed to heritability. Endothelial function affects aerobic power. Various physiological pathways may influence the endothelial function. Therefore, we aimed to examine whether polymorphisms of the eNos gene, the CAT gene, the VEGF gene, the GPX1 gene, the subunit P22 phox of the NAD(P)H-odixase gene, the PPAR-alpha gene, and the PGC-alpha gene are associated with aerobic power or with its response to physical training in patients with coronary artery disease (CAD). METHODS 935 biologically unrelated Caucasian patients with CAD who had exercised until exhaustion during graded bicycle testing at baseline and after completion of 3 months of training were included in the CAREGENE study (Cardiac Rehabilitation and GENetics of exercise performance). Polymorphisms were detected using the invader assay and MassARRAY technology. Haplotype analysis was performed on the polymorphisms of the eNos gene, the VEGF gene and the NAD(P)H-oxidase gene. RESULTS Physical training significantly increased aerobic power by 24.2 +/- 0.6% (P < 0.001). Associations of P < 0.05 were found between aerobic power and the eNOS 273C>T variant and the catalase -262C>T variant and aerobic power response. Haplotypes of the eNOS polymorhisms were predictive of aerobic power and its response to training (P < 0.05). After Bonferroni correction of multiple testing no significant differences remained. CONCLUSION We believe that genetic factors are very important in the explanation of the great variability of aerobic power and its response. However, after Bonferroni-correction, differences in these polymorphisms remained no longer statistically significant.
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Affiliation(s)
- Steven Onkelinx
- Cardiovascular Rehabilitation Unit, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium
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