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Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, De la Rosa MJ, Maldonado J, Neira Ojeda C, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, Valdes Gonzalez Y, Wood PW, Zuniga E, Ordunez P. [Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation GroupFactores impulsores y métodos de puntuación para mejorar el control de la hipertensión en la práctica clínica de la atención primaria: recomendaciones del grupo de innovación de HEARTS en las Américas]. Rev Panam Salud Publica 2022; 46:e68. [PMID: 35573115 PMCID: PMC9097925 DOI: 10.26633/rpsp.2022.68] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fundamentos. As doenças cardiovasculares (DCV) são as principais causas de morbimortalidade nas Américas, e a hipertensão arterial (HÁ) é o fator de risco modificável mais importante. Porém, as taxas de controle da HA continuam baixas, e a mortalidade por DCV está estagnada ou aumentando após décadas de redução contínua. Em 2016, a Organização Mundial da Saúde (OMS) lançou o pacote de medidas técnicas HEARTS para melhorar o controle da HA. A Organização Pan-Americana da Saúde (OPAS) criou a iniciativa HEARTS nas Américas para melhorar a gestão do risco cardiovascular (RCV), com ênfase no controle da HA. Até agora, essa iniciativa foi implementada em 21 países. Métodos. Para impulsionar a implementação, recrutou-se um grupo multidisciplinar de profissionais para selecionar impulsionadores-chave do controle da HA com base em evidências e elaborar um scorecard completo para monitorar sua implementação em unidades de atenção primária à saúde (APS). O grupo estudou sistemas de saúde com alto desempenho que haviam conseguido atingir um alto nível de controle da HA por meio de programas de melhoria da qualidade focados em medidas específicas de processo, com feedback regular para os profissionais das unidades de saúde. Resultados. Os oito fatores impulsionadores incluídos na seleção final foram categorizados em cinco domínios principais: (1) diagnóstico (exatidão da medição da pressão arterial e avaliação do RCV); (2) tratamento (protocolo padronizado de tratamento e intensificação do tratamento); (3) continuidade do cuidado e acompanhamento; (4) modelo de atenção (atendimento baseado em equipe, renovação da prescrição); e (5) sistema de avaliação do desempenho. Em seguida, os fatores impulsionadores e as recomendações foram transformados em medidas de processo, gerando dois scorecards inter-relacionados integrados ao sistema de monitoramento e avaliação da Iniciativa HEARTS nas Américas. Interpretação. O foco nesses impulsionadores-chave da HA e nos scorecards resultantes orientará o processo de melhoria da qualidade para atingir as metas de controle, a nível populacional, dos centros de saúde participantes nos países que estão implementando a iniciativa HEARTS.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group Los Angeles EUA Southern California Permanente Medical Group, Los Angeles, EUA.,Departamento de Ciências de Sistemas de Saúde Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena EUA Departamento de Ciências de Sistemas de Saúde, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA
| | - Gloria P Giraldo Arcila
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Teresa Aumala
- Centro de Atenção Primária à Saúde Ministério da Saúde, Centro de Salud Conocoto Quito Equador Centro de Atenção Primária à Saúde, Ministério da Saúde, Centro de Salud Conocoto, Quito, Equador
| | - Allana Best
- Ministério da Saúde Porto de Espanha Trinidad e Tobago Ministério da Saúde, Porto de Espanha, Trinidad e Tobago
| | - Norm Rc Campbell
- Departamento de Medicina Fisiologia e Farmacologia e Ciências da Saúde Comunitária Libin Cardiovascular Institute of Alberta Calgary Canadá Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde Comunitária, Libin Cardiovascular Institute of Alberta, Calgary, Canadá
| | - Shana Cyr
- Ministério da Saúde Bem-Estar e Idosos Castries Santa Lúcia Ministério da Saúde, Bem-Estar e Idosos, Castries, Santa Lúcia
| | - Angelo Gamarra
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Marc G Jaffe
- Departamento de Endocrinologia The Permanente Medical Group Kaiser San Francisco Medical Center San Francisco EUA Departamento de Endocrinologia, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, EUA
| | - Mirna Jimenez De la Rosa
- Escola de Saúde Pública Faculdade de Ciências da Saúde Universidad Autónoma de Santo Domingo República Dominicana Escola de Saúde Pública, Faculdade de Ciências da Saúde, Universidad Autónoma de Santo Domingo, República Dominicana.,Oficina Escuela de Salud Publica Ciudad Universitaria Universidad Autónoma de Santo Domingo Distrito Nacional República Dominicana Oficina Escuela de Salud Publica, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, República Dominicana
| | - Javier Maldonado
- Organização Pan-Americana da Saúde Bogotá Colômbia Organização Pan-Americana da Saúde, Bogotá, Colômbia
| | - Carolina Neira Ojeda
- Departamento de Doenças Não Transmissíveis Ministério da Saúde Santiago do Chile Chile Departamento de Doenças Não Transmissíveis, Ministério da Saúde, Santiago do Chile, Chile
| | - Modesta Haughton
- Organização Pan-Americana da Saúde Ancón Panamá Organização Pan-Americana da Saúde, Ancón, Panamá
| | - Taraleen Malcolm
- Organização Pan-Americana da Saúde Porto de Espanha Trinidad e Tobago Organização Pan-Americana da Saúde, Porto de Espanha, Trinidad e Tobago
| | - Vivian Perez
- Organização Pan-Americana da Saúde Lima Peru Organização Pan-Americana da Saúde, Lima, Peru
| | - Gonzalo Rodriguez
- Organização Pan-Americana da Saúde Ciudad Autónoma de Buenos Aires Buenos Aires Argentina Organização Pan-Americana da Saúde, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Yamile Valdes Gonzalez
- Comitê Técnico Consultivo Nacional de Hipertensão Arterial Hospital Universitário "General Calixto García" Havana Cuba Comitê Técnico Consultivo Nacional de Hipertensão Arterial, Hospital Universitário "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Departamento de Medicina Divisão de Medicina Interna Geral University of Alberta Edmonton Canadá Departamento de Medicina, Divisão de Medicina Interna Geral, University of Alberta, Edmonton, Canadá
| | - Eric Zuniga
- Servicio de Salud Antofagasta Universidad de Antofagasta Antofagasta Chile Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
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Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, De la Rosa MJ, Maldonado J, Neira Ojeda C, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, Valdes Gonzalez Y, Wood PW, Zuñiga E, Ordunez P. [Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation GroupFatores impulsionadores e scorecards para melhorar o controle da hipertensão arterial na atenção primária: recomendações do Grupo de Inovação da Iniciativa HEARTS nas Américas]. Rev Panam Salud Publica 2022; 46:e56. [PMID: 35573117 PMCID: PMC9097922 DOI: 10.26633/rpsp.2022.56] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antecedentes. Las enfermedades cardiovasculares (ECV) son la principal causa de morbilidad y mortalidad en la Región de las Américas y la hipertensión es el factor de riesgo modificable asociado más importante. Sin embargo, las tasas de control de la hipertensión siguen siendo bajas y la mortalidad por ECV está estancada o en aumento después de décadas de reducción continua. En el 2016, la Organización Mundial de la Salud (OMS) presentó el paquete técnico HEARTS para mejorar el control de la hipertensión. La Organización Panamericana de la Salud (OPS) diseñó la iniciativa HEARTS en las Américas para mejorar el control del riesgo de ECV, que hace hincapié en el control de la hipertensión y que, hasta la fecha, se ha implementado en 21 países. Métodos. Para avanzar en la implementación, se creó un grupo interdisciplinario de profesionales de la salud con el objetivo de seleccionar los factores impulsores claves del control de la hipertensión basados en la evidencia y diseñar un método de puntuación integral para dar seguimiento a su implementación en los centros de atención de salud primaria (APS). El grupo estudió los sistemas de salud de alto desempeño que logran un control elevado de la hipertensión mediante programas de mejora de la calidad que se centran en medidas específicas con respecto a los procesos, con retroalimentación regular a los prestadores en los centros de salud. Resultados. Los ocho factores impulsores finales seleccionados se clasificaron en cinco dominios principales: 1) diagnóstico (exactitud de la medición de la presión arterial y evaluación del riesgo de ECV); 2) tratamiento (protocolo de tratamiento e intensificación del tratamiento estandarizados); 3) continuidad de la atención y seguimiento; 4) sistema de prestación del tratamiento (atención basada en un trabajo en equipo, reposición de la medicación) y 5) sistema para la evaluación del desempeño. Los factores impulsores y las recomendaciones se tradujeron en medidas con respecto a los procesos, lo que llevó a dos métodos de puntuación integrados e interconectados en el sistema de seguimiento y evaluación del programa HEARTS en las Américas. Conclusiones. El enfoque que se centra en estos factores impulsores clave de la hipertensión y los métodos de puntuación resultantes servirá de guía para el proceso de mejora de la calidad con objeto de alcanzar los objetivos de control a nivel poblacional en los centros de salud participantes de los países que implementan el programa HEARTS.
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Affiliation(s)
- Jeffrey W Brettler
- Kaiser Permanente del Sur de California Los Ángeles Estados Unidos de América Kaiser Permanente del Sur de California, Los Ángeles, Estados Unidos de América.,Departamento de Ciencias de Sistemas de Salud Facultad de Medicina Bernard J. Tyson de Kaiser Permanente Pasadena Estados Unidos de América Departamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América
| | - Gloria P Giraldo Arcila
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Teresa Aumala
- Centro de Atención Primaria de Salud Ministerio de Salud Centro de Salud Conocoto Quito Ecuador Centro de Atención Primaria de Salud, Ministerio de Salud, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministerio de Salud Puerto España Trinidad y Tabago Ministerio de Salud, Puerto España, Trinidad y Tabago
| | - Norm Rc Campbell
- Departamento de Medicina Fisiología y Farmacología y Ciencias de Salud Comunitaria Instituto Cardiovascular Libin de Alberta Calgary Canadá Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud Comunitaria, Instituto Cardiovascular Libin de Alberta, Calgary, Canadá
| | - Shana Cyr
- Ministerio de Salud Bienestar y Asuntos de la Tercera Edad Castries Santa Lucía Ministerio de Salud, Bienestar y Asuntos de la Tercera Edad, Castries, Santa Lucía
| | - Angelo Gamarra
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Marc G Jaffe
- Departamento de Endocrinología Grupo Médico Permanente Centro Médico de San Francisco Kaiser San Francisco Estados Unidos de América Departamento de Endocrinología, Grupo Médico Permanente, Centro Médico de San Francisco Kaiser, San Francisco, Estados Unidos de América
| | - Mirna Jimenez De la Rosa
- Escuela de Salud Pública Facultad de Ciencias de la Salud Universidad Autónoma de Santo Domingo Santo Domingo Dominican Republic Escuela de Salud Pública, Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana.,Oficina Escuela de Salud Pública Ciudad Universitaria Universidad Autónoma de Santo Domingo Santo Domingo República Dominicana Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Javier Maldonado
- Organización Panamericana de Salud Bogotá Colombia Organización Panamericana de Salud, Bogotá, Colombia
| | - Carolina Neira Ojeda
- Departamento de Enfermedades no Transmisibles Ministerio de Salud Santiago de Chile Chile Departamento de Enfermedades no Transmisibles, Ministerio de Salud, Santiago de Chile, Chile
| | - Modesta Haughton
- Organización Panamericana de Salud Ancon Panamá Organización Panamericana de Salud, Ancon, Panamá
| | - Taraleen Malcolm
- Organización Panamericana de la Salud Puerto España Trinidad y Tabago Organización Panamericana de la Salud, Puerto España, Trinidad y Tabago
| | - Vivian Perez
- Organización Panamericana de Salud Lima Perú Organización Panamericana de Salud, Lima, Perú
| | - Gonzalo Rodriguez
- Organización Panamericana de la Salud Ciudad Autónoma de Buenos Aires Argentina Organización Panamericana de la Salud, Ciudad Autónoma de Buenos Aires, Argentina
| | - Andres Rosende
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Yamile Valdes Gonzalez
- Comité Técnico Asesor Nacional sobre Hipertensión Hospital Universitario "General Calixto García" La Habana Cuba Comité Técnico Asesor Nacional sobre Hipertensión, Hospital Universitario "General Calixto García", La Habana, Cuba
| | - Peter W Wood
- Departamento de Medicina División de Medicina Interna General Universidad de Alberta Edmonton Canadá Departamento de Medicina, División de Medicina Interna General, Universidad de Alberta, Edmonton, Canadá
| | - Eric Zuñiga
- Servicios de Salud Antofagasta Universidad de Antofagasta Antofagasta Chile Servicios de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
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Brettler JW, Arcila GPG, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, la Rosa MJD, Maldonado J, Ojeda CN, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, González YV, Wood PW, Zúñiga E, Ordunez P. Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group. Lancet Reg Health Am 2022; 9:None. [PMID: 35711685 PMCID: PMC9121401 DOI: 10.1016/j.lana.2022.100223] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Americas, and hypertension is the most significant modifiable risk factor. However, hypertension control rates remain low, and CVD mortality is stagnant or rising after decades of continuing reduction. In 2016, the World Health Organization (WHO) launched the HEARTS technical package to improve hypertension control. The Pan American Health Organization (PAHO) designed the HEARTS in the Americas Initiative to improve CVD risk management, emphasizing hypertension control, to date implemented in 21 countries. Methods To advance implementation, an interdisciplinary group of practitioners was engaged to select the key evidence-based drivers of hypertension control and to design a comprehensive scorecard to monitor their implementation at primary care health facilities (PHC). The group studied high-performing health systems that achieve high hypertension control through quality improvement programs focusing on specific process measures, with regular feedback to providers at health facilities. Findings The final selected eight drivers were categorized into five main domains: (1) diagnosis (blood pressure measurement accuracy and CVD risk evaluation); (2) treatment (standardized treatment protocol and treatment intensification); (3) continuity of care and follow-up; (4) delivery system (team-based care, medication refill), and (5) system for performance evaluation. The drivers and recommendations were then translated into process measures, resulting in two interconnected scorecards integrated into the HEARTS in the Americas monitoring and evaluation system. Interpretation Focus on these key hypertension drivers and resulting scorecards, will guide the quality improvement process to achieve population control goals at the participating health centers in HEARTS implementing countries. Funding No funding to declare.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group, Los Angeles, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Gloria P Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Teresa Aumala
- Primary Health Care Center, Ministry of Health, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministry of Health, Park Street, Port of Spain, Trinidad and Tobago
| | - Norm Rc Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Shana Cyr
- Ministry of Health, Wellness & Elderly Affairs, Sir Stanislaus James Building, Waterfront, Castries, Saint Lucia
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Mirna Jimenez De la Rosa
- School of Public Health, Faculty of Health Sciences, Universidad Autónoma de Santo Domingo, Dominican Republic.,Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, Dominican Republic
| | | | - Carolina Neira Ojeda
- Department of Noncommunicable Diseases, Ministry of Health, Santiago de Chile, Chile
| | | | - Taraleen Malcolm
- Pan American Health Organization (PAHO), Port of Spain, Trinidad and Tobago
| | - Vivian Perez
- Pan American Health Organization,(PAHO), Lima, Peru
| | - Gonzalo Rodriguez
- Pan American Health Organization, (PAHO), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Yamilé Valdés González
- National Technical Advisory Committee on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Zúñiga
- Health Services Antofagasta, Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
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Padwal R, Wood PW. Digital Health Approaches for the Assessment and Optimisation of Hypertension Care Provision. Can J Cardiol 2020; 37:711-721. [PMID: 33340672 DOI: 10.1016/j.cjca.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022] Open
Abstract
Although many aspects of our lives have been transformed by digital innovation, widespread adoption of digital health advancements within the health care sector in general, and for hypertension care specifically, has been limited. However, it is likely that, over the next decade, material increases in the uptake of digital health innovations for hypertension care delivery will be seen. In this narrative review, we summarise those innovations thought to have the greatest chance for impact in the next decade. These include provision of virtual care combined with home blood pressure (BP) telemonitoring, use of digital registries and protocolised care, leveraging continuous BP measurement to collect vast amounts of individual and population-based BP data, and adoption of digital therapeutics to provide low-cost scalable interventions for patients with or at risk for hypertension. Of these, home BP telemonitoring is likely the most ready for implementation, but it needs to be done in a way that enables efficient guideline-concordant care in a cost-effective manner. In addition, efforts must be focused on implementing digital health solutions in a manner that addresses the major challenges to digital adoption. This entails ensuring that innovations are accessible, usable, secure, validated, evidence based, cost-effective, and integrated into the electronic systems that are already used by patients or providers. Increasing the use of broader digital innovations such as artificial/augmented intelligence, data analytics, and interactive voice response is also critically important. The digital revolution holds substantial promise, but success will depend on the ability of collaborative stakeholders to adopt and implement innovative, usable solutions.
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Affiliation(s)
- Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Peter W Wood
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ringrose JS, Wood PW, Diaz-Carvallo F, Wirzba M, Padwal R. Validation of the BIOS BD240 home blood pressure monitor in a multi-racial, multi-morbid Canadian population according to the International Standards Organization 2018 Protocol. Blood Press Monit 2020; 25:167-170. [PMID: 32187037 DOI: 10.1097/mbp.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assess the accuracy of the BIOS BD240 home blood pressure (BP) monitor and wide-range cuff according to the International Organization for Standardization (ISO) 2018 standard. METHODS Eighty-five subjects (aged ≥18 y) with arm circumferences between 24 and 43 cm were studied. Blinded, two-observer, mercury-based auscultation performed using a two-piece cuff chosen for upper arm size was used for reference measurements. Accuracy criteria 1 and 2 of the ISO standard were determined and Bland-Altman plots generated. RESULTS Sixty percent of the study sample was female and 42% had hypertension. Mean device-to-reference standard differences in SBP/DBP were 0.0 ± 6.2/-0.2 ± 6.3 for criterion 1 and 0.0 ± 4.8/-0.2 ± 5.8 for criterion 2. CONCLUSION The BIOS BD240 passed the requirements of the American National Standards Institute/Association for the Advancement of Medical Instrumentation/ISO standard for both SBP and DBP and can be recommended for use.
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Padwal RS, So H, Wood PW, Mcalister FA, Siddiqui M, Norris CM, Jeerakathil T, Stone J, Valaire S, Mann B, Boulanger P, Klarenbach SW. Cost-effectiveness of home blood pressure telemonitoring and case management in the secondary prevention of cerebrovascular disease in Canada. J Clin Hypertens (Greenwich) 2018; 21:159-168. [DOI: 10.1111/jch.13459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/29/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Raj S. Padwal
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
- Mazankowski Heart Institute; Edmonton Alberta Canada
| | - Helen So
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Peter W. Wood
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Finlay A. Mcalister
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
- Mazankowski Heart Institute; Edmonton Alberta Canada
| | - Muzaffar Siddiqui
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Colleen M. Norris
- Mazankowski Heart Institute; Edmonton Alberta Canada
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Tom Jeerakathil
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - James Stone
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - Shelley Valaire
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - Balraj Mann
- Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network; Edmonton Alberta Canada
| | - Pierre Boulanger
- Department of Computing Science; University of Alberta; Edmonton Alberta Canada
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Albrecht L, Wood PW, Fradette M, McAlister FA, Rabi D, Boulanger P, Padwal R. Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study. JMIR Aging 2018; 1:e10975. [PMID: 31518242 PMCID: PMC6716488 DOI: 10.2196/10975] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. OBJECTIVE The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. METHODS We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. RESULTS Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. CONCLUSIONS Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population.
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Affiliation(s)
- Lauren Albrecht
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Peter W Wood
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Miriam Fradette
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Doreen Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Pierre Boulanger
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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8
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Wood PW, Gibson PH, Becher H. Three-dimensional echocardiography in a dynamic heart phantom: comparison of five different methods to measure chamber volume using a commercially available software. Echo Res Pract 2014; 1:51-60. [PMID: 26693301 PMCID: PMC4676488 DOI: 10.1530/erp-14-0051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022] Open
Abstract
Several methods of analysis are available for quantification of left ventricular volumes and ejection fraction using three-dimensional (3D) echocardiography. This study compared the accuracy and reproducibility of five methods of analysis in a novel, irregularly shaped dynamic heart phantom with excellent image quality. Five 3D datasets were acquired on a Philips IE33 platform using an X5-1 3D transducer. Each dataset was analysed by five different methods using the Philips QLab v8.1 software: Methods A1, A2 and A3, semi-automated contour detection with varying degrees of user correction; Method B, Simpson's biplane method using optimally aligned four- and two-chamber views and Method C, method of discs, manually delineated in reconstructed short-axis views. Time-volume curves were generated for each method and compared with the true volumes measured throughout systole in the phantom heart. A second observer repeated measurements by each method in a single 3D dataset. Method A1 (uncorrected semi-automated contouring) produced the most consistent time-volume curves, although end-diastolic and end-systolic volumes varied between datasets. Any manual correction of contours (Methods A2, A3 and B) resulted in significant variation in the time-volume curves, with less consistent endocardial tracking. Method C was not only the most accurate and reproducible method, but also the most time-consuming one. Different methods of 3D volume quantification vary significantly in accuracy and reproducibility using an irregular phantom heart model. Although contouring may appear optimal in long-axis views, this may not be replicated circumferentially, and the resulting measures appeared to be less robust following the manual correction of semi-automated contours.
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Affiliation(s)
- Peter W Wood
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital , 0A8.32, 8440 - 112 Street, Edmonton, Alberta , Canada T6G 2B7
| | - Patrick H Gibson
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital , 0A8.32, 8440 - 112 Street, Edmonton, Alberta , Canada T6G 2B7
| | - Harald Becher
- ABACUS, Mazankowski Alberta Heart Institute, University of Alberta Hospital , 0A8.32, 8440 - 112 Street, Edmonton, Alberta , Canada T6G 2B7
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9
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Abstract
Background and Methods In order to provide guidance for using measurements of left ventricular (LV) volume and ejection fraction (LVEF) from different echocardiographic methods a PubMed review was performed on studies that reported reference values in normal populations for two-dimensional (2D ECHO) and three-dimensional (3D ECHO) echocardiography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging (CMR). In addition all studies (2 multicenter, 16 single center) were reviewed, which included at least 30 patients, and the results compared of noncontrast and contrast 2D ECHO, and 3D ECHO with those of CMR. Results The lower limits for normal LVEF and the normal ranges for end-diastolic (EDV) and end-systolic (ESV) volumes were different in each method. Only minor differences in LVEF were found in studies comparing CMR and 2D contrast echocardiography or noncontrast 3D echocardiography. However, EDV and ESV measured with all echocardiographic methods were smaller and showed greater variability than those derived from CMR. Regarding agreement with CMR and reproducibility, all studies showed superiority of contrast 2D ECHO over noncontrast 2D ECHO and 3D ECHO over 2D ECHO. No final judgment can be made about the comparison between contrast 2D ECHO and noncontrast or contrast 3D ECHO. Conclusion Contrast 2D ECHO and noncontrast 3D ECHO show good reproducibility and good agreement with CMR measurements of LVEF. The agreement of volumes is worse. Further studies are required to assess the clinical value of contrast 3D ECHO as noncontrast 3D ECHO is only reliable in patients with good acoustic windows.
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Affiliation(s)
- Peter W Wood
- Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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10
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Abstract
The effects of cultured host Schwann cells on axonal regeneration in peripheral nerve allografts were studied. Fischer rats served as recipient animals and Buffalo rats provided nerve allografts. Animals were randomized into 9 groups. Rats receiving tibial nerve isografts were left untreated (group I), or injected with isogeneic Fischer Schwann cells (group II) or placebo suspension (group III). Allografts obtained from Buffalo rats were left untreated (group IV), or received isogeneic Fischer Schwann cells (group V), 2 mg/kg Cyclosporin A and Fischer Schwann cells (group VI), 5 mg/kg Cyclosporin A (group VII), or 5 mg/kg Cyclosporin A with Schwann cells (group VIII). No Schwann cell tumors were identified 4 or 8 weeks postoperatively. Group IX animals, harvested 3 days postoperatively, demonstrated no evidence of injection injury. Schwann cells modestly improved axonal regeneration in both isografts and allografts and may have a clinical role in the treatment of peripheral nerve allografts.
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Affiliation(s)
- M A Ogden
- Division of Plastic Surgery, Washington University, St. Louis, MO 63110, USA
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Luby CK, Wood PW. Thrombotic thrombocytopenia purpura. Dimens Crit Care Nurs 1985; 4:209-14. [PMID: 3848383 DOI: 10.1097/00003465-198507000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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13
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Osofsky HJ, Rajan R, Wood PW, DiFlorio R. An interdisciplinary program for low income pregnant schoolgirls: a progress report. J Reprod Med 1970; 5:103-9. [PMID: 5521776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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15
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Osofsky HJ, Hagen JH, Braen BB, Wood PW, DiFlorio R. Problems of the pregnant school girl. An attempted solution. N Y State J Med 1967; 67:2332-43. [PMID: 5234046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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