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Kapoor A, Patel P, Chennupati S, Mbusa D, Sadiq H, Rampam S, Leung R, Miller M, Vargas KR, Fry P, Lowe MM, Catalano C, Harrison C, Catanzaro JN, Crawford S, Smith AM. Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study. JMIR Cardio 2024; 8:e49590. [PMID: 38265849 PMCID: PMC10851125 DOI: 10.2196/49590] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal-based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown. OBJECTIVE This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL). METHODS Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA2DS2-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute). RESULTS We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001). CONCLUSIONS Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach.
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Affiliation(s)
- Alok Kapoor
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Parth Patel
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Soumya Chennupati
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Daniel Mbusa
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Hammad Sadiq
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Sanjeev Rampam
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Robert Leung
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Megan Miller
- College of Pharmacy, University of Florida, Jacksonville, FL, United States
| | | | - Patrick Fry
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | | | - Christina Catalano
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | - Charles Harrison
- College of Medicine, University of Florida, Jacksonville, FL, United States
| | | | - Sybil Crawford
- University of Massachusetts Chan Medical School, Worcester, MA, United States
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Pham T, Patel P, Mbusa D, Kapoor A, Crawford S, Sadiq H, Rampam S, Wagner J, Gurwitz JH, Mazor KM. Impact of a pharmacist intervention on DOAC knowledge and satisfaction in ambulatory patients. J Thromb Thrombolysis 2023; 55:346-354. [PMID: 36510110 DOI: 10.1007/s11239-022-02743-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
Patient education of high-risk medications such as direct oral anticoagulants (DOACs) is limited in ambulatory care settings. Clinical pharmacists are uniquely equipped to educate patients about DOACS but seldom interact with patients in those settings where patient education and satisfaction are often overlooked. Recently, the Anticoagulation Forum endorsed a checklist (DOAC Checklist) to guide and educate patients initiating or resuming DOACs. We assessed the impact on knowledge and satisfaction of an intervention framed around the checklist. Randomized clinical trial. Ambulatory patients starting a DOAC or resuming one after setback (bleeding, stroke, or transient ischemic attack) in an ambulatory setting (office, emergency department, or short stay hospitalization). Three educational clinical pharmacist tele-visits, hotline access to the pharmacist, and coordination with continuity providers in 3 months. Patient knowledge scores from a 15-item DOAC-related questionnaire and satisfaction scores from an abbreviated version of the Duke Anticoagulation Satisfaction Survey (DASS). Of 561 randomized patients, 436 completed our follow-up surveys. Knowledge scores were similar for the 233 intervention patients vs. 203 control patients (63.7% vs 62.2% correct). Satisfaction scores on the 7-point Likert scale were virtually identical (6.24 and 6.22). Our pharmacist-led intervention framed around the DOAC checklist had little impact on knowledge and satisfaction. Delays between intervention end and completion of the follow-up questionnaires may have obscured benefits experienced earlier. More intensive education or strategies other than telephone-based consultation may be required to produce sustained knowledge.TRN: NCT04068727 retrospectively registered on August 22, 2019.
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Affiliation(s)
- Thu Pham
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Parth Patel
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Daniel Mbusa
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Alok Kapoor
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA.
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Hammad Sadiq
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Sanjeev Rampam
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Joann Wagner
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
| | - Jerry H Gurwitz
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
- Reliant Medical Group, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North - S6-750, Worcester, MA, 01605, USA
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Filippaios A, Tran KV, Mehawej J, Ding E, Paul T, Lessard D, Otabil EM, Noorishirazi K, Naeem S, Sadiq H, Howard-Wilson S, Soni A, Saczynski J, McManus DD. Patient activation and health-related quality-of-life in association with smartwatch alerts for atrial fibrillation detection. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2827] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Smartwatches with various alert systems are becoming increasingly popular in the detection of atrial fibrillation (AF) post stroke, however their impact on psychological well-being remains unknown.
Purpose
Assess the association between smartwatch alerts for detected atrial fibrillation in older stroke survivors and patient activation as well as health-related quality-of-life.
Methods
Data were used from the Pulsewatch study, a multiphase, randomized controlled trial, which enrolled older adults (≥50 years of age) from the UMass Memorial Health System with history of a stroke and no contraindications to anticoagulation, who were given a smartwatch for AF detection. In Phase I, participants were randomized 3:1 (intervention:control) to receive a smartwatch/smartphone pair and an FDA-approved cardiac patch monitor or only the patch (control) to monitor for AF for 14 days. In Phase II, participants were re-randomized 1:1, with the intervention group being offered the smartwatch/smartphone pair for an extra 30 days. Participants were grouped into those receiving at least one alert of a possible abnormal rhythm versus those who did not receive any alerts from their smartwatch. At baseline, 14 days, and 44 days the Consumer Health Activation Index was used to assess patient activation and the Physical and Mental Component Summary of Short-Form Health Survey were utilized to evaluate physical and mental health-related quality-of-life, respectively. Mixed-effects repeated measures linear regression models were used to examine changes in patient activation and physical and mental health-related quality-of-life, in relation to alerts, adjusting for confounding variables including age, sex, race, history of arrhythmias, history of congestive heart failure, history of coronary artery disease, baseline depression, and baseline cognitive impairment, over the study period.
Results
94 participants (64.6±9.1 years of age, 87.2% non-Hispanic white, and 43.6% female) were included in the analysis; 16 of whom received at least one alert. Specifically, twelve participants received 1 to 3 alerts, three participants received 11 to 18, and one participant received 226. In fully adjusted models, receiving alerts was not associated with changes in patient activation or mental health-related quality-of-life (β −1.70, p-value 0.60 and β 2.85, p-value 0.09 respectively), but was associated with a significant reduction in physical health-related quality-of-life (β −4.67, p-value 0.04).
Conclusions
In a cohort of older stroke survivors who wore smartwatches for up to 44 days, reception of alerts was not significantly associated with changes in patient activation or mental health-related quality-of-life but was significantly related to a decline in physical health-related quality-of-life. Further studies are necessary to explore the use of smartwatches in AF screening and their impact on psychological health and quality-of-life.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): R01HL137734 from the National Heart, Lung, and Blood Institute
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Affiliation(s)
- A Filippaios
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - K V Tran
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - J Mehawej
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - E Ding
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - T Paul
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - D Lessard
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - E M Otabil
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - K Noorishirazi
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - S Naeem
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - H Sadiq
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - S Howard-Wilson
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - A Soni
- University of Massachusetts Chan Medical School , Worcester , United States of America
| | - J Saczynski
- Northeastern University , Boston , United States of America
| | - D D McManus
- University of Massachusetts Chan Medical School , Worcester , United States of America
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Filippaios A, Tran KVT, Mehawej J, Ding E, Paul T, Lessard D, Barton B, Lin H, Naeem S, Otabil EM, Noorishirazi K, Dai Q, Sadiq H, Chon KH, Soni A, Saczynski J, McManus DD. Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection. Cardiovasc Digit Health J 2022; 3:198-200. [PMID: 36310684 PMCID: PMC9596300 DOI: 10.1016/j.cvdhj.2022.07.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Khanh-Van T Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Qiying Dai
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Hammad Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Sadiq H, Rampam S, Patel J, Crawford S, Walz M, Kapoor A. Preoperative walking intervention did not appear to improve patient-reported postoperative recovery in older adults with frailty traits: Randomized trial. Medicine (Baltimore) 2022; 101:e30689. [PMID: 36197179 PMCID: PMC9509049 DOI: 10.1097/md.0000000000030689] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess the impact of a preoperative walking intervention on improving postoperative recovery in at-risk frail older adult patients. STUDY TYPE Unblinded, randomized controlled trial which assigned patients to intervention versus control. POPULATION Patients aged 60+ scheduled for surgery 3-8 weeks from randomization scoring 4+ on the Edmonton Frail Scale. INTERVENTION Preoperative walking enhanced by goal setting with an activity monitor and telephonic coaching. MAIN OUTCOMES Quality of Recovery 9-item instrument total score and a modified version of the Abdominal Surgery Impact Scale total score. RESULTS A total of 83 patients were analyzed. Postoperative recovery scores were similar in intervention vs control - Quality of Recovery-9 item instrument total score 14.1 vs. 14.1 (P = .94) and modified Abdominal and Surgery Impact Scale total score 82.8 vs. 79.2 (P = .93). Few intervention patients met their daily step count goals. Despite this, intervention patients improved average daily step counts significantly. CONCLUSIONS Preoperative walking bolstered with activity monitor and remote coaching did not appear to lead to improved postoperative recovery in older adults with frailty traits. Further research is necessary to see if a similar intervention in specific surgery types or a more intense version of the intervention can improve recovery.
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Affiliation(s)
| | | | - Jay Patel
- UMass Chan Medical School, Worcester, MA, USA
| | | | - Matthias Walz
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Health, Worcester, MA USA
| | - Alok Kapoor
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Health, Worcester, MA USA
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Fitzpatrick M, Sadiq H, Rampam S, Araia A, Miller M, Vargas KR, Fry P, Smith AM, Lowe MM, Catalano C, Harrison C, Catanzaro J, Crawford S, McManus D, Kapoor A. Preventing preventable strokes: A study protocol to push guideline-driven atrial fibrillation patient education via patient portal. Cardiovascular Digital Health Journal 2022; 3:241-246. [PMID: 36310680 PMCID: PMC9596318 DOI: 10.1016/j.cvdhj.2022.07.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/30/2022] Open
Abstract
Background The main approach to preventing stroke in patients with atrial fibrillation (AF) is anticoagulation (AC), but only about 60% of at-risk individuals are on AC. Patient-facing electronic health record–based interventions have produced mixed results. Little is known about the impact of health portal–based messaging on AC use. Objective The purpose of this study was describe a protocol we will use to measure the association between AC use and patient portal message opening. We also will measure patient attitudes toward education materials housed on a professional society Web site. Methods We will send portal messages to patients aged ≥18 years with AF 1 week before an office/teleconference visit with a primary care or cardiology provider. The message will be customized for 3 groups of patients: those on AC; those at elevated risk but off AC; and those not currently at risk but may be at risk in the future. Within the message, we will embed a link to UpBeat.org, a Web site of the Heart Rhythm Society containing patient educational materials. We also will embed a link to a survey. Among other things, the survey will request patients to rate their attitude toward the Heart Rhythm Society Web pages. To measure the effectiveness of the intervention, we will track AC use and its association with message opening, adjusting for potential confounders. Conclusion If we detect an increase in AC use correlates with message opening, we will be well positioned to conduct a future comparative effectiveness trial. If patients rate the UpBeat.org materials highly, patients from other institutions also may benefit from receiving these materials.
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Affiliation(s)
- Michael Fitzpatrick
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Hammad Sadiq
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sanjeev Rampam
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Almaz Araia
- Department of Practice Improvement and Policy, Heart Rhythm Society, Washington, District of Columbia
| | - Megan Miller
- Department of Medicinal Chemistry, University of Florida College of Pharmacy, Jacksonville, Florida
| | - Kevin Rivera Vargas
- Department of Medicinal Chemistry, University of Florida College of Pharmacy, Jacksonville, Florida
| | - Patrick Fry
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Anne Marie Smith
- Department of Practice Improvement and Policy, Heart Rhythm Society, Washington, District of Columbia
| | | | - Christina Catalano
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Charles Harrison
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - John Catanzaro
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Alok Kapoor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Memorial Health Care, Worcester, Massachusetts
- Address reprint requests and correspondence: Dr Alok Kapoor, Biotech One, Suite 100, University of Massachusetts Medical School, 365 Plantation St, Worcester, MA 01605.
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Rampam S, Sadiq H, Patel J, Meyer D, Uy K, Yates J, Schanzer A, Movahedi B, Lindberg J, Crawford S, Gurwitz J, Mazor K, Stefan M, White D, Walz M, Kapoor A. Supervised preoperative walking on increasing early postoperative stamina and mobility in older adults with frailty traits: A pilot and feasibility study. Health Sci Rep 2022; 5:e738. [PMID: 35873397 PMCID: PMC9301296 DOI: 10.1002/hsr2.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/31/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 12/18/2022] Open
Abstract
Background and Aims Frail older adults are more than twice as likely to experience postoperative complications. Preoperative exercise may better prepare these patients through improved stamina and mobility experienced in the days following surgery. We measured the impact of a walking intervention using an activity tracker and coaching on postoperative stamina, and mobility in older adults with frailty traits. Methods We included patients aged 60+ and scoring 4+ on the Edmonton Frailty Scale. We then randomized patients to intervention versus control stratified by anticipated hospital stay (1 night vs. 2+ night) and baseline stamina (i.e., 6-min walk distance [6MWD]). Intervention patients received an activity tracker and linked smart phone. An athletic trainer (AT) prescribed a daily step count goal and titrated this up after checking in with patients during weekly telephone calls. Controls received general walking recommendations. We then measured postoperative 6MWD 1-3 days after surgery. We also assessed postoperative mobility by measuring steps walked the day after surgery using a thigh-worn monitor. Because many patients could not walk postoperatively, we compared intervention-control difference in both 6MWD and steps using Wilcoxon rank testing and Tobit and ordinal logistic regression adjusting for several patient characteristics. Results We randomized 104 eligible patients; 80 patients remained for final analysis. There was no difference in intervention versus control postoperative 6MWD (median 72 vs. 74 m Wilcoxon p = 0.54) or postoperative steps taken (median 128 vs. 51 steps Wilcoxon p = 0.76). Analysis adjusting for patient characteristics was consistent with these findings. Conclusion Our intervention consisting of goal setting with an activity tracker and telephonic coaching by an AT did not appear to improve stamina or mobility measured in the days after surgery. Small sample size limited our ability to examine this impact in subsets defined by surgical specialty or baseline stamina.
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Affiliation(s)
- Sanjeev Rampam
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA
| | - Hammad Sadiq
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA
| | - Jay Patel
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA
| | - David Meyer
- Hospital Medicine UMass Memorial Health Worcester Massachusetts USA.,Department of Surgery UMass Chan Medical School Worcester MA USA
| | - Karl Uy
- Department of Surgery UMass Chan Medical School Worcester MA USA.,Thoracic Surgery UMass Memorial Health Worcester MA USA
| | - Jennifer Yates
- Department of Urology UMass Chan Medical School Worcester MA USA.,Urology UMass Memorial Health Worcester MA USA
| | - Andres Schanzer
- Department of Surgery UMass Chan Medical School Worcester MA USA.,Vascular Surgery UMass Memorial Health Worcester MA USA
| | - Babak Movahedi
- Department of Surgery UMass Chan Medical School Worcester MA USA.,Transplant Surgery UMass Memorial Health Worcester MA USA
| | - James Lindberg
- Department of Surgery UMass Chan Medical School Worcester MA USA.,Surgical Oncology UMass Memorial Health Worcester MA USA
| | - Sybil Crawford
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA
| | - Jerry Gurwitz
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA.,Department of Medicine Meyers Health Care Institute Worcester Massachusetts USA
| | - Kathleen Mazor
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA.,Department of Medicine Meyers Health Care Institute Worcester Massachusetts USA
| | - Mihaela Stefan
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA.,Medicine Baystate Medical Center Springfield Massachusetts USA
| | - Daniel White
- Department of Physical Therapy University of Delaware Newark Delaware USA
| | - Matthias Walz
- Department of Anesthesiology and Perioperative Medicine UMass Chan Medical School Worcester MA USA.,Anesthesiology UMass Memorial Health Worcester MA USA
| | - Alok Kapoor
- Department of Medicine UMass Chan Medical School Worcester Massachusetts USA.,Hospital Medicine UMass Memorial Health Worcester Massachusetts USA.,Department of Medicine Meyers Health Care Institute Worcester Massachusetts USA
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Patel J, Sadiq H, Catanzaro J, Crawford S, Wright A, Manning G, Allison J, Mazor K, McManus D, Kapoor A. SUPPORT-AF IV: Supporting use of AC through provider prompting about oral anticoagulation therapy for AF clinical trial study protocol. Cardiovasc Digit Health J 2022; 2:222-230. [PMID: 35265912 PMCID: PMC8890051 DOI: 10.1016/j.cvdhj.2021.06.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Six million Americans suffer from atrial fibrillation (AF), a heart rhythm abnormality that significantly increases the risk of stroke. AF is responsible for 15% of ischemic strokes, which lead to permanent disability in 60% of cases and death in up to 20%. Anticoagulation (AC) is the mainstay for stroke prevention in patients with AF. Despite guidelines recommending AC for patients, up to half of eligible patients are not on AC. Clinical decision support tools in the electronic health record (EHR) can help bridge the disparity in AC prescription for patients with AF. Objective To enhance and assess the effectiveness of our previous rule-based alert on AC initiation and persistence in a diverse patient population from UMass-Memorial Medical Center and University of Florida at Jacksonville. Methods/Results Using the EHR, we will track AC initiation and persistence. We will interview both patients and providers to determine a measure of satisfaction with AC management. We will track digital crumbs to better understand the alert’s mechanism of effect and further add enhancements. These enhancements will be used to refine the alert and aid in developing an implementation toolkit to facilitate use of the alert at other health systems. Conclusion If the number of AC starts, the likelihood of persisting on AC, and the frequency alert use are found to be higher among intervention vs control providers, we believe such findings will confirm our hypothesis on the effectiveness of our alert.
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Affiliation(s)
- Jay Patel
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hammad Sadiq
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - John Catanzaro
- Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Adam Wright
- Department of Biomedical Informatics, University of Vanderbilt School of Medicine, Nashville, Tennessee
| | - Gordon Manning
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Jeroan Allison
- University of Massachusetts Memorial Health Care, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kathleen Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Memorial Health Care, Worcester, Massachusetts.,Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
| | - David McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Alok Kapoor
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Memorial Health Care, Worcester, Massachusetts
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Kapoor A, Sadiq H, Patel J, Zhang N, Mazor K, Crawford S, Chen Z, Gurwitz J, McManus D, Hanchate A. Disparities in Anticoagulation Use by Race and Ethnicity in Long-Term Care Residents With Atrial Fibrillation. J Am Heart Assoc 2021; 10:e023428. [PMID: 34816732 PMCID: PMC9075411 DOI: 10.1161/jaha.121.023428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alok Kapoor
- University of Massachusetts Medical SchoolWorcesterMA
- University of Massachusetts Memorial Medical CenterWorcesterMA
- A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon HealthMeyers Primary Care InstituteWorcesterMA
| | - Hammad Sadiq
- University of Massachusetts Medical SchoolWorcesterMA
| | - Jay Patel
- University of Massachusetts Medical SchoolWorcesterMA
| | - Ning Zhang
- A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon HealthMeyers Primary Care InstituteWorcesterMA
- Department of Health Policy and PromotionSchool of Public Health and Health SciencesUniversity of Massachusetts AmherstAmherstMA
| | - Kathleen Mazor
- University of Massachusetts Medical SchoolWorcesterMA
- A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon HealthMeyers Primary Care InstituteWorcesterMA
| | - Sybil Crawford
- University of Massachusetts Medical SchoolWorcesterMA
- A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon HealthMeyers Primary Care InstituteWorcesterMA
| | - Zhiyong Chen
- University of Massachusetts Medical SchoolWorcesterMA
- Zem Data Science, LLCNorth PotomacMD
| | - Jerry Gurwitz
- University of Massachusetts Medical SchoolWorcesterMA
- A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon HealthMeyers Primary Care InstituteWorcesterMA
| | - David McManus
- University of Massachusetts Medical SchoolWorcesterMA
- A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon HealthMeyers Primary Care InstituteWorcesterMA
| | - Amresh Hanchate
- Department of Social Sciences and HealthWake Forest School of MedicineWinston‐SalemNC
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10
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Ko D, Saleeba C, Sadiq H, Crawford S, Paul T, Shi Q, Wang Z, Benjamin EJ, Walkey AJ, Lubitz SA, Kapoor A, McManus D. Secondary Precipitants of Atrial Fibrillation and Anticoagulation Therapy. J Am Heart Assoc 2021; 10:e021746. [PMID: 34668392 PMCID: PMC8751824 DOI: 10.1161/jaha.121.021746] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation (AF) commonly occurs in the setting of acute conditions. We aimed to identify the acute conditions associated with secondary AF (AF precipitants) including pneumonia/sepsis, pneumothorax, respiratory failure, myocarditis, pericarditis, alcohol intoxication, thyrotoxicosis, cardiothoracic surgery, other surgery in patients with newly diagnosed AF and determine their association with subsequent oral anticoagulant use. Methods and Results We assembled a cohort of patients in the UMass Memorial Healthcare system with a new diagnosis of AF with and without AF precipitants. We used combinations of International Classification of Diseases, Tenth Revision (ICD-10) codes, Current Procedural Terminology codes, laboratory values, imaging reports, and physician notes including discharge summary texts to identify AF precipitants. We then manually reviewed the individual charts to validate presence of AF precipitants. The study sample consisted of 185 patients with and 172 patients without AF precipitants. Pneumonia/sepsis, myocardial infarction, respiratory failure, and cardiothoracic surgery were the most common precipitants identified. In multivariable analyses adjusting for age, sex, patient comorbidities, left atrial enlargement, left ventricular ejection fraction, and antiplatelet use, patients with AF precipitants were less likely to receive subsequent anticoagulation therapy at 30 days after the initial AF diagnosis (odds ratio, 0.31; 95% CI, 0.19-0.52). The association was persistent after excluding men with CHA2DS2-VASc score <2 and women with CHA2DS2-VASc score <3. Conclusions Our study highlights lower usage of oral anticoagulant in secondary AF in contemporary clinical practice.
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Affiliation(s)
- Darae Ko
- Section of Cardiovascular Medicine Boston University School of Medicine Boston MA
| | - Connor Saleeba
- Department of Medicine UMass Medical School Worcester MA
| | - Hammad Sadiq
- Department of Medicine UMass Medical School Worcester MA
| | - Sybil Crawford
- Graduate School of Nursing UMass Medical School Worcester MA
| | - Tenes Paul
- Department of Medicine UMass Medical School Worcester MA
| | - Qiming Shi
- Center for Clinical and Translational Science UMass Medical School Worcester MA
| | - Ziyue Wang
- Department of Medicine UMass Medical School Worcester MA
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine Boston University School of Medicine Boston MA.,Department of Epidemiology Boston University School of Public Health Boston MA
| | - Allan J Walkey
- The Pulmonary Center Boston University School of Medicine Boston MA.,Department of Health Law, Policy, & Management Boston University School of Public Health Boston MA
| | - Steven A Lubitz
- Cardiovascular Research Center and Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Alok Kapoor
- Department of Medicine UMass Medical School Worcester MA
| | - David McManus
- Department of Medicine UMass Medical School Worcester MA
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11
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Sadiq H, Hoque L, Shi Q, Manning G, Crawford S, McManus D, Kapoor A. SUPPORT-AF III: supporting use of AC through provider prompting about oral anticoagulation therapy for AF. J Thromb Thrombolysis 2021; 52:808-816. [PMID: 33694097 DOI: 10.1007/s11239-021-02420-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
Only half of atrial fibrillation (AF) patients with elevated stroke risk receive anticoagulation (AC). Electronic health record (EHR) alerts have the potential to close the gap. We designed an outpatient EHR alert (linked to an order set for ordering AC, labs, and specialty referrals) that fired when cardiology and primary care providers (PCPs) saw AF patients not on AC. We assigned all untreated patients seen by cardiology providers and PCPs in the 8 months before and after the alert launch to pre- and post-launch intervention cohorts, respectively. Untreated AF patients seeing other types of providers became controls. We then compared the difference in AC starts between intervention and control patients post-launch to the same difference prelaunch (adjusting for covariates). We measured alert responsiveness as how often patients had at least one encounter with a provider, who interacted with the alert. The adjusted percentage of AC starts for the prelaunch cohort was 20% for intervention patients and 17% for controls (difference = 3%); post-launch, the percentage was 13% for both post-launch intervention and controls (difference = 0%). The difference in difference was - 3% (p value 0.63). For half of patients, at least one provider was responsive to our alert. Reasons for no AC commonly included relative contraindications (e.g. fall, gastrointestinal bleed). Our alert did not increase AC starts but responsiveness to it was high. Increasing AC starts will likely require education surrounding relative contraindications.
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Affiliation(s)
- Hammad Sadiq
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Laboni Hoque
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Qiming Shi
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Gordon Manning
- University of Massachusetts Medical School, Worcester, MA, USA.,UMass Memorial Health Care, Worcester, MA, USA
| | - Sybil Crawford
- University of Massachusetts Medical School, Worcester, MA, USA
| | - David McManus
- University of Massachusetts Medical School, Worcester, MA, USA.,UMass Memorial Health Care, Worcester, MA, USA
| | - Alok Kapoor
- University of Massachusetts Medical School, Worcester, MA, USA. .,UMass Memorial Health Care, Worcester, MA, USA. .,Biotech One, University of Massachusetts Medical School, 365 Plantation Street, Suite 100, Worcester, MA, 01605, USA.
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12
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Elsobky S, Ahmad N, Qureshi M, Izzath W, Sadiq H. Paediatric day case tonsillectomy: a safe, feasible and an economical way to treat patients – Yorkhill experience. Scott Med J 2014; 59:5-8. [DOI: 10.1177/0036933013518140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Day case surgery is widely encouraged as it has many benefits. In this study, we evaluate the feasibility of paediatric tonsillectomies as day case surgery procedures in a tertiary paediatric centre. Methods The outcome of paediatric tonsillectomy performed as day case procedures was studied for four months. We recorded complication rates in comparison to the standard in-patient practice. Results 23 paediatric patients were included in this study. The age of the patients ranged from four to 11 years, with mean age of 6.5. No patients suffered post-operative complications within the first 24 h. Two patients were re-admitted due to a post-operative complication (8.6%) and one patient for a non-operative cause (4.3%) beyond the initial 24 h. Conclusion Paediatric Day Case Paediatric Tonsillectomy is a safe, feasible and an economical way to manage patients. It should be practised as a day case where appropriate and when criteria are met.
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Affiliation(s)
- S Elsobky
- Research Associate & Junior Doctor, Royal Hospital for Sick Children, UK; College of Medicine, University of Glasgow, UK
| | - N Ahmad
- Junior Doctor, Royal Hospital for Sick Children, UK; College of Medicine, University of Glasgow, UK
| | - M Qureshi
- Medical Student, Royal Hospital for Sick Children, UK; College of Medicine, University of Glasgow, UK
| | - W Izzath
- Junior Doctor, Royal Hospital for Sick Children, UK
| | - H Sadiq
- Consultant Doctor, Royal Hospital for Sick Children, UK
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13
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Shah SK, Sadiq H, Khalil M, Noor A, Rasheed G, Shah SM, Ahmad N. Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan? East Mediterr Health J 2003. [DOI: 10.26719/2003.9.4.776] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As private medical practitioners play a major role of in providing care to pulmonary tuberculosis [TB] patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed [80%] and treated [83%] cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority [76%] used only clinical assessment
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14
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Shah SK, Sadiq H, Khalil M, Noor A, Rasheed G, Shah SM, Ahmad N. Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan? East Mediterr Health J 2003; 9:776-88. [PMID: 15748074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
As private medical practitioners play a major role of in providing care to pulmonary tuberculosis (TB) patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed (80%) and treated (83%) cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority (76%) used only clinical assessment.
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Affiliation(s)
- S K Shah
- National Tuberculosis Control Programme, Rawalpindi, Pakistan
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15
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Sadiq H, Muynck AD. Health care seeking behavior of pulmonary tuberculosis patients visiting TB Center Rawalpindi. J PAK MED ASSOC 2001; 51:10-6. [PMID: 11255991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To determine the health care seeking behavior of TB patients in seeking care and health care providers for delivering care. DESIGN Cross sectional descriptive survey. The interviewers administered a standardized open-ended questionnaire after training and pre-testing. SETTING Federal Government TB Center, Rawalpindi. (specialized TB clinic). SUBJECT One hundred and sixty newly registered TB patients at TB Center, Rawalpindi between 20 November to 21 December 1998. RESULTS Prior to their consulting TB Center, 96% patients had already reported to a health care provider, i.e., to first, second or third health care providers. OF 154 patients, 48 were diagnosed as TB and only 29 (19%) of them received antituberculosis treatment. Most of the patients 118 (77%) consulted the health care provider within three weeks time. CONCLUSION Delay is more on part of health care providers than on patients. Proper implementation of guidelines of TB program with public-private sector collaboration and continuing education of health care providers is necessary.
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Affiliation(s)
- H Sadiq
- DOTS Project TB Center, Rawalpindi
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16
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De Muynck A, Siddiqi S, Ghaffar A, Sadiq H. Tuberculosis control in Pakistan: critical analysis of its implementation. J PAK MED ASSOC 2001; 51:41-7. [PMID: 11255999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A De Muynck
- GTZ/HSA, Islamabad, Health Services Academy, Islamabad
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Abstract
Leishmaniasis is an uncommon condition in Western Europe, except around the Mediterranean coast. However, it may occasionally be seen in the United Kingdom, in patients who acquired the infection in foreign lands. An unusual case of localized cutaneous leishmaniasis recidiva affecting the nose after septal surgery is presented.
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Affiliation(s)
- G A Vernham
- Department of Otolaryngology, Victoria Infirmary, Glasgow
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