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Williamson MD, Grubic N, Moulson N, Johri AM. Comparative evaluation of an electrocardiogram workflow model for athletic cardiovascular screening: Primary care network versus sports cardiology interpretation. J Electrocardiol 2023; 81:36-40. [PMID: 37517199 DOI: 10.1016/j.jelectrocard.2023.07.007] [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: 04/29/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Electrocardiogram (ECG) testing in pre-participation screening (PPS) remains controversial due to its cost, resource dependency, and the potential for inaccurate interpretations. At most centres, ECGs are conducted internally by providers trained in athletic ECG interpretation. Outsourcing ECG requisitions to an athlete's primary care network (PCN) may reduce institutional demands. This study compared PCN-conducted athletic ECG interpretation to expert sports cardiology interpretation. METHODS This was a retrospective, single-centre chart-review study of all athletes who underwent cardiovascular PPS between 2017 and 2021. All athletes submitted an ECG with their screening package, which was conducted and interpreted within their PCN. All ECGs were reinterpreted by a sports cardiologist using the International Criteria (IC) for electrocardiographic interpretation in athletes. Overall, positive, and negative percent agreement were used to compare PCN-conducted ECG interpretation with IC interpretation. RESULTS A total of 740 athletes submitted a screening package with a valid ECG (mean age: 18.5 years, 39.6% female). PCN-conducted ECGs were interpreted by 181 unique physicians. Among 41 (5.5%) PCN-conducted ECGs that were initially interpreted as abnormal, only 5 (0.7%) were classified as abnormal according to the IC. All PCN-conducted ECGs reported as normal were also classified as normal according to the IC. The overall agreement between PCN-conducted and IC ECG interpretation was 95.1% (positive percent agreement: 100%, negative percent agreement: 95.1%). CONCLUSIONS Normal PCN-conducted athletic ECGs are interpreted with high agreement to the IC. Majority of PCN-conducted ECGs interpreted as abnormal are indeed normal as per the IC. These findings suggest that a PPS workflow model that outsources ECG requisitions to a PCN may be a reliable approach to PPS, all while reducing screening-related institutional costs and resource requirements.
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Affiliation(s)
| | - Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Georges JL, Gaulupeau V, Chanut A, Merceron A, Delaroche-Vernet S, Harboun M, Chayeb S, Sadeg O, Aribi EH, Galindo G, Sekour K, Bornand A, Romain D. [Management of congestive heart failure in the elderly after hospitalization for acute decompensation Interest of a dedicated territorial geriatric network ; the GERICCO-78 study]. Ann Cardiol Angeiol (Paris) 2022; 71:259-266. [PMID: 36041961 DOI: 10.1016/j.ancard.2022.08.002] [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: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
AIMS Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients. METHODS From 01/10/2019 to 01/10/2021, 237 patients aged > 75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge. RESULTS The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction > 40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients. CONCLUSION This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations.
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Affiliation(s)
- Jean-Louis Georges
- Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 177 rue de Versailles, 78157, Le Chesnay-Rocquencourt, France.
| | - Violaine Gaulupeau
- Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, 177 rue de Versailles, 78157, Le Chesnay-Rocquencourt, France
| | - Anais Chanut
- Infirmière Coordinatrice, Cellule de coordination ville-hôpital, et réseau REPY, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Annick Merceron
- Infirmière Coordinatrice, Cellule de coordination ville-hôpital, et réseau REPY, Centre Hospitalier de Plaisir, Plaisir, France
| | - Sophie Delaroche-Vernet
- Infirmière Coordinatrice, Cellule de coordination ville-hôpital, et réseau REPY, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Marc Harboun
- Service de gériatrie aiguë et soins de suite gériatrique, Hôpital Privé de la Porte Verte, Versailles, France
| | - Samir Chayeb
- Service de Cardiologie, Centre Hospitalier de Rambouillet, Rambouillet, France
| | - Ouali Sadeg
- Service de gériatrie aiguë , Centre Hospitalier de Plaisir, Plaisir, France
| | - El Heddi Aribi
- Service de soins de suite gériatriques, Centre Hospitalier de Plaisir, Plaisir, France
| | - Géraldine Galindo
- Service de gériatrie aiguë, Centre Hospitalier de Rambouillet, Rambouillet, France
| | - Kaci Sekour
- Service de médecine et soins de suite gériatriques, Centre Hospitalier de la Mauldre, Jouars Pontchartrain, France
| | - Anne Bornand
- Service de gériatrie aiguë, Pôle de gériatrie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Delphine Romain
- Service de soins de suite gériatriques, Pôle de gériatrie, Centre Hospitalier de Versailles, Hôpital Richaud, Versailles, France
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Surendran S, Foo CD, Matchar DB, Ansah JP, Car J, Koh GCH. Developing integration among stakeholders in the primary care networks of Singapore: a qualitative study. BMC Health Serv Res 2022; 22:782. [PMID: 35706015 PMCID: PMC9198200 DOI: 10.1186/s12913-022-08165-1] [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] [Received: 02/16/2022] [Accepted: 06/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Integrating healthcare services across and between the different health system levels can be achieved in a few ways; however, examining the social side of integration is essential and challenging. This paper explores the concept of integration perceived by general practitioners (GPs) and primary care network (PCN) representatives from the regional health systems (RHS) in a GP-RHS PCN and their perceived partnership success. METHODS In this study, we explored three GP-RHS PCNs in Singapore. We used a qualitative research design and, overall, performed 17 semi-structured in-depth interviews with GPs (n = 11) and PCN representatives (n = 6) from the RHS. All interviews were audiotaped and transcribed verbatim. We conducted thematic analysis to inductively identify themes from the data. Singer's conceptual model of integration types was used as guiding principles to derive relevant and salient themes for integration. RESULTS GPs and the RHS perceived the concept of integration through a series of interrelated strategies. Within the normative dimension, a sense of urgency motivated GPs to integrate improvements into their general practice. Participants perceived teamwork and relational climate as appropriate enablers for achieving interpersonal integration in a primary care partnership. While developing a trusted relationship was a perceived success of this partnership across the network, developing camaraderie and gaining knowledge in chronic disease management through the components of functional integration was a perceived success at an individual general practice level. The data also revealed some operational challenges within the structural dimension and some inabilities of the PCN to achieve complete process integration. CONCLUSIONS Our study points to multi-faceted integration, comprising various forms that need to be manifested at all levels of care to achieve coordinated, seamless, and comprehensive care for patients suffering from chronic conditions. The present iteration of the PCN has been shown to offer integration at a level that warrants praise but still requires structural and process integration improvement.
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Affiliation(s)
- Shilpa Surendran
- grid.4280.e0000 0001 2180 6431Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
| | - Chuan De Foo
- grid.4280.e0000 0001 2180 6431Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
| | - David Bruce Matchar
- grid.428397.30000 0004 0385 0924Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - John Pastor Ansah
- grid.428397.30000 0004 0385 0924Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Josip Car
- grid.59025.3b0000 0001 2224 0361Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gerald Choon Huat Koh
- grid.4280.e0000 0001 2180 6431Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
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Beniston J. Tavistock Neighbourhood Nursing Network: collaboration across settings. Br J Community Nurs 2020; 25:122-125. [PMID: 32160028 DOI: 10.12968/bjcn.2020.25.3.122] [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] [Indexed: 06/10/2023]
Abstract
The modern matron role in Tavistock has been developed to extend beyond the community hospital to oversee the provision of high-quality care across community nursing services by promoting a collaborative approach to learning and development, via the establishment of a Neighbourhood Nursing Network (NNN). The Tavistock NNN helps nurses to support each other to improve practice and work collaboratively. The aim is to target health promotion and ill health prevention where it will be most effective in order to make services sustainable for the future, including engaging with young people for the purpose of preventing illness. By being part of the network, the nurses have greater power to identify patients or groups of patients at risk of health inequalities and develop innovative ways to promote good health and prevent ill health. The project aims to ensure that high-quality care is delivered throughout the neighbourhood, giving patients and residents the confidence that standards will be consistent in all settings. The network has removed barriers between nursing services and facilitated multidisciplinary working for the benefit of the community they serve.
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Affiliation(s)
- Joanne Beniston
- Modern Matron, Tavistock Neighbourhood, Tavistock, West Devon
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