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Adoption of self-measured blood pressure monitoring in underserved communities: Program evaluation in primary care
No full textRationale: Self-measured blood pressure (SMBP) monitoring is crucial for hypertension management, yet its adoption, particularly among disadvantaged populations, remains low. \u27Love Your Heart\u27 is a quality improvement program providing free standard SMBP devices to hypertensive patients, aiming to enhance adoption and assess its impact on blood pressure control.
Aims and objectives: This study evaluates the \u27Love Your Heart\u27 program\u27s implementation success through assessing adoption rates and exploring changes in systolic blood pressure (SBP) among participants. We aim to understand factors influencing adoption and potential benefits of SMBP monitoring in a diverse, socially disadvantaged patient population.
Methods: We retrospectively evaluated the \u27Love Your Heart\u27 program using electronic health records (EHR) at a primary care site in Chicago. Adult patients with hypertension were enroled in the 6-month program, which included education sessions and free SMBP devices. Adoption was measured by participation in program components, and changes in SBP were analysed based on adoption status. Statistical analyses were conducted using SAS software, adhering to STROBE reporting guidelines.
Results: Of 621 eligible patients, 104 participated, with 83 included in the evaluation. Despite all participants receiving free SMBP devices, adoption rates were modest, with only 7% sharing readings with the care team. However, patients who received device instructions demonstrated greater decreases in SBP compared to those who did not. Although not statistically significant, clinically meaningful decreases in SBP were observed among adopters.
Conclusion: The \u27Love Your Heart\u27 program highlights the challenges of promoting SMBP monitoring among disadvantaged patient populations. While providing free devices addresses access barriers, low reporting to the care team suggests the need for further support mechanisms. Future research should explore strategies to enhance SMBP adoption and integration into clinical care, particularly in settings lacking automated data transmission systems
Poor correlation of venous lactate with systemic oxygen saturation in the paediatric cardiac ICU: A pilot study
No full textIntroduction:Cardiac intensive care providers require a comprehensive understanding of cardiac output and oxygen delivery. The estimation of cardiac output in clinical practice often relies on thermodilution and the Fick principle. Central venous saturation and lactate levels are commonly used indicators for cardiac output assessment. However, the relationship between venous lactate levels and venous oxygen saturation in paediatric cardiac intensive care patients remains unclear.
Methods:This is a single-centre retrospective pilot study aimed to investigate the correlation between venous lactate and venous oxygen saturation in paediatric patients. Data collected included venous saturation, heart rate, mean arterial blood pressure, arterial saturation by pulse oximetry, cerebral and renal near-infra-red spectroscopy values, and the presence of a functionally univentricular heart. Statistical analyses included Bayesian Pearson correlation and regression analyses.
Results:A total of 203 data points from 37 unique patients were included in the analysis. There was no significant correlation between serum lactate and venous saturation (correlation coefficient = -0.01; Bayes factor 10 = 0.06). Serum lactate also did not correlate with other haemodynamic metrics. Venous saturation showed correlations with arterial saturation and cerebral and renal near-infra-red spectroscopy. Regression analysis revealed that parallel circulation, arterial saturation, and cerebral near-infra-red spectroscopy were predictive of venous saturation. The following equation resulted from the regression analysis: 68.0 - (12.7 x parallel circulation) - (0.8 x arterial saturation) + (0.3 x cerebral near-infra-red spectroscopy). This model had a Bayes factor 10 of 0.03 and adjusted R-squared was 0.29.
Conclusion:In paediatric cardiac intensive care patients, there is no significant correlation between venous lactate and venous saturation, suggesting that lactate may not be a reliable marker for assessing the adequacy of oxygen delivery in this population. Only a weak correlation could be identified once the venous saturation was 70% or lower. Additional research is needed to explore alternative markers for monitoring oxygen delivery in critically ill paediatric patients
Large-bore mechanical thrombectomy versus catheter-directed thrombolysis in the management of intermediate-risk pulmonary embolism: Primary results of the PEERLESS randomized controlled trial
No full textBackground:There is a lack of randomized controlled trial (RCT) data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism (PE).
Methods:PEERLESS is a prospective, multicenter, RCT that enrolled 550 intermediate-risk PE patients with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary endpoint was a hierarchal win ratio (WR) composite of the following: 1) all-cause mortality, 2) intracranial hemorrhage, 3) major bleeding, 4) clinical deterioration and/or escalation to bailout, and 5) postprocedural intensive care unit (ICU) admission and length of stay, assessed at the sooner of hospital discharge or 7 days post-procedure. Assessments at the 24-hour visit included respiratory rate, mMRC dyspnea score, NYHA classification, right ventricle (RV)/left ventricle (LV) ratio reduction, and RV function. Endpoints through 30 days included total hospital stay, all-cause readmission, and all-cause mortality.
Results:The primary endpoint occurred significantly less frequently with LBMT vs CDT (WR 5.01 [95% CI: 3.68-6.97]; PP=0.04) with LBMT vs CDT and less postprocedural ICU utilization (P24 hours (19.3% vs 64.5%). There was no significant difference in mortality, intracranial hemorrhage, or major bleeding between strategies, nor in a secondary WR endpoint including the first 4 components (WR 1.34 [95% CI: 0.78-2.35]; P=0.30). At the 24-hour visit, respiratory rate was lower for LBMT patients (18.3±3.3 vs 20.1±5.1; PPP=0.002), and RV dysfunction (42.1% vs 57.9%; P=0.004). RV/LV ratio reduction was similar (0.32±0.24 vs 0.30±0.26; P=0.55). LBMT patients had shorter total hospital stays (4.5±2.8 vs 5.3±3.9 overnights; P=0.002) and fewer all-cause readmissions (3.2% vs 7.9%; P=0.03), while 30-day mortality was similar (0.4% vs 0.8%; P=0.62).
Conclusions:PEERLESS met its primary endpoint in favor of LBMT vs CDT in treatment of intermediate-risk PE. LBMT had lower rates of clinical deterioration and/or bailout and postprocedural ICU utilization compared with CDT, with no difference in mortality or bleeding
The Pulse, 1985, N10, Autumn
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2037/thumbnail.jp
The Pulse, 1989 Fall
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2042/thumbnail.jp
The Pulse, 1996, V6 N3, Summer
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2069/thumbnail.jp
The Pulse, 1997, V7 N4, August
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2074/thumbnail.jp
The Pulse, 1998, V8 N2, Spring
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2077/thumbnail.jp
The Pulse, 2001, V11 N3, Summer
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2089/thumbnail.jp
The Pulse, 2002, V10 N4, Fall
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2093/thumbnail.jp