P2519Multiprofessional intervention for fostering self management capabilities for patients with chronic heart disease - development of a common curriculum (MIFeSCH)

Background

Chronic cardiovascular disease (CAD) still is the leading cause of death in industrialized countries in spite of substantial progress in diagnostics and therapy. Programs of lifestyle management are effective but insufficiently established in usual patient care. The authors provide multi professional educational courses to strengthen self management capabilities for cardiovascular patients in five different institutions in Europe since up to 20 years in modification of the program of Dr. Dean Ornish. Physicians, psychologists, dietitians and artistic and movement therapists work together in courses lasting from half a year to one year.

To implement their programs in daily care, an association of these five institutions will evaluate a common lifestyle management program in four phases: 1. development of a common curriculum, 2. pilot study, 3. interventional study, 4. implementation study.

Phase 1 is now completed. The evaluation will show, whether this lifestyle management program leads to improvement of health in patients and in the therapeutic team.

Purpose of phase 1: development of a common curriculum by the five active members of the association.

Methods

The five existing educational programs were assessed and differences between the programs themselves and other existing programs of patient education were defined. Distinctive and common features of the different institutions were recorded. Structured interviews with members of all institutions acquired content, methods and eductional goals of the interventions according to predefined criteria for patient education programs in the respective countries. The results were discussed, reflected and a common curriculum was consented.

Results

The consented multi professional curriculum, comprising the activities of five active heart education programs defines five different levels of competence which are key of their patient education goals: (1) reflective self-awareness (I-competence), (2) artistic competence, (3) competence of ensouled movement, (4) nutritional competence and (5) social competence.

The main difference between the already existing programs for patients with CAD and the newly developed curriculum is the emphasis on training the participants' self awareness and social competence, for example by biography work in an interdisciplinary approach.

Levels of competence

Conclusion

The process of generating a common curriculum of competence levels, educational goals and necessary methods comprising the work of five different but associated institutions was successful. A pilot study will now be performed to show the effects of this program on cardiovascular health and quality of live of study participants and the therapeutic team as well to show, whether this intervention reduces the risk of burn out for the therapists.

By this the authors hope to implement their education program according to the curriculum as an improvement of standard therapy for patients with cardiovascular disease.

Acknowledgement/Funding

Universität Witten-Herdecke

Fn-type chicory inulin hydrolysate has a prebiotic effect in humans

The partial enzymatic hydrolysis of chicory inulin (GFn; 2 < or =n < or =60) yields an oligofructose preparation that is composed of both GFn-type and Fn-type oligosaccharides (2 < or =n < or =7; 2 < or =m < or =7), where G is glucose, F is fructose, and n is the number of beta(2-->1) bound fructose moieties. Human studies have shown that feeding GFn-type oligomers significantly modifies the composition of the fecal microflora especially by increasing the number of bifidobacteria. The experiments reported here were used to test the hypothesis that the Fn-type molecules have the same property. During a controlled feeding study, 8 volunteers (5 females and 3 males) consumed 8 g/d of an Fn-rich product for up to 5 wk. Fecal samples were collected and analyzed for total anaerobes, bifidobacteria, lactobacilli, bacteroides, coliforms and Clostridium perfringens. Both 2 and 5 wk of oligofructose feeding resulted in a selective increase in bifidobacteria (P<0.01). In addition, a daily intake of 8 g of the Fn-type oligofructose preparation reduced fecal pH and caused little intestinal discomfort.