Evaluation of a Video-Assisted Patient Education Program to Reduce Blood Pressure Delivered Through the Electronic Medical Record: Results of a Quality Improvement Project

BACKGROUND

Low-cost, automated interventions that increase knowledge and skills around diet and lifestyle modifications are recommended for cardiovascular disease risk reduction.

METHODS

We initiated a quality improvement program to assess the impact of a web-based diet and lifestyle intervention utilizing short animated videos in adults with high blood pressure (BP) at a primary care clinic in Saudi Arabia. We enrolled adults with elevated BP, not on BP medications, who were identified using the electronic medical record. We delivered a web-linked diet and lifestyle intervention using animated videos covering diet and lifestyle topics. Videos and reminders were sent weekly for 5 weeks. Outcomes were proportion who engaged in the program, returned for a repeat BP within 3 months, and change in BP.

RESULTS

We enrolled 269 adult participants, with a mean (SD) age of 41.6 (12.4) years; 77% were male. At the conclusion of the pilot, we demonstrated a high level of engagement: overall, 69% of materials were viewed and 67% of patients returned for BP. Patients who returned had a mean (SD) baseline systolic BP of 138.0 (7.2) mm Hg and a large mean reduction in systolic BP from baseline, -10.5 mm Hg (12.4; P < 0.001).

CONCLUSIONS

Overall, the feasibility of a video-assisted, web-based, diet and lifestyle intervention as a support tool for hypertension management demonstrated a high participation rate and a high return rate for reassessment of BP. These findings suggest that this low-cost, automated intervention may have a great potential as a scalable tool for blood pressure management. However, randomized trials to understanding the effectiveness of the support tools are needed.

Adsorption of Cu(II), Co(II), and Ni(II) ions by modified magnetic chitosan chelating resin

Cross-linked magnetic chitosan-isatin Schiff's base resin (CSIS) was prepared for adsorption of metal ions. CSIS obtained was investigated by means of FTIR, (1)H NMR, wide-angle X-ray diffraction (WAXRD), magnetic properties and thermogravimetric analysis (TGA). The adsorption properties of cross-linked magnetic CSIS resin toward Cu(2+), Co(2+) and Ni(2+) ions were evaluated. Various factors affecting the uptake behavior such as contact time, temperature, pH and initial concentration of the metal ions were investigated. The kinetic parameters were evaluated utilizing the pseudo-first-order and pseudo-second-order. The equilibrium data were analyzed using the Langmuir, Freundlich, and Tempkin isotherm models. The adsorption kinetics followed the mechanism of the pseudo-second-order equation for all systems studied, evidencing chemical sorption as the rate-limiting step of adsorption mechanism and not involving a mass transfer in solution. The best interpretation for the equilibrium data was given by Langmuir isotherm, and the maximum adsorption capacities were 103.16, 53.51, and 40.15mg/g for Cu(2+), Co(2+) and Ni(2+) ions, respectively. Cross-linked magnetic CSIS displayed higher adsorption capacity for Cu(2+) in all pH ranges studied. The adsorption capacity of the metal ions decreased with increasing temperature. The metal ion-loaded cross-linked magnetic CSIS were regenerated with an efficiency of greater than 88% using 0.01-0.1M ethylendiamine tetraacetic acid (EDTA).

Adsorption of Cu(II), Hg(II), and Ni(II) ions by modified natural wool chelating fibers

The graft copolymerization of ethyl acrylate (EA) onto natural wool fibers initiated by potassium persulphate and Mohr's salt redox initiator system in limited aqueous medium was carried out in heterogeneous media. Ester groups of the grafted copolymers were partially converted into hydrazide function groups followed by hydrazone formation through reaction with isatin. Also the application of the modified fibers for metal ion uptake was studied using Cu(II), Hg(II) and Ni(II). The modified chelating fibers were characterized using FTIR spectroscopy, SEM and X-ray diffraction.

Aetiological factors of obesity in children

A survey was carried out of the prevalence of obesity in 7600 schoolchildren aged 11-16 years in Cairo. Weight, height and skinfold thicknesses were measured and the children classified as underweight, normal or overweight. Overweight children were further screened for obesity, a triceps skinfold thickness of greater than 18 mm for boys and greater than 25 mm for girls being taken as the lower level of obesity. Age at menarche, birth order, social class, obesity in other members of the family, food habits and dietary intakes were all studied. The prevalence of obesity in Egyptian children was comparable to that in the US. The study emphasizes the importance of social and cultural influences in the development of obesity in Egyptian children.