1,721,023 research outputs found
De papieren mens
No full textSir William Osler schreef in het jaar 1901 het volgende: "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all". De man is intussen reeds 102 jaar overleden, maar zijn uitspraak houdt nog steeds stand. Het nut van actief leren toont zich op verschillende manieren. Enerzijds is er de voorbereiding op examens door studenten. Onderzoek toont systematisch aan dat actieve leermethoden in de geneeskunde (vragen op-lossen, zichzelf bevragen of patiëntencasussen analyseren) betere examenresultaten opleveren dan passieve methoden (de aangeduide tekst herlezen of samenvatten). Anderzijds is er de praktijk: de beste leerschool voor de klinische praktijk is wellicht de klinische praktijk zelf. Toch helpt het om af en toe de zeekaarten aan te scherpen. Zeldzaamheden doen zich immers niet elke dag voor en een zeldzame pathologie leent zich dus bij uitstek tot het putten uit wat collega's hebben meegemaakt. Ik herinner me dat ik een collega sprak kort na een belangrijk examen waarvoor we studeerden aan de hand van klinische casussen. Hij was die week terug aan het werk op de spoedgevallendienst. Hij vertelde me dat hij nu, zonder er actief over na te denken, met een nieuwe systematiek werkte. Na zoveel 'papieren patiënten' bleek het eenvoudiger om de anamnese, de parameters, het klinische onderzoek en de afwijkende resultaten aan elkaar te breien. Op die manier kon hij makkelijker zeldzaamheden oppikken. Van alle studiebronnen komt het bestuderen van papieren casussen wellicht het dichtst in de buurt van de klinische praktijk, met als voordeel dat dit in alle rust en veiligheid kan gebeuren. Dit themanummer met klinische casussen dient als voorbereiding op ieders komende zeetochten en helpt om de zeeën beter in kaart te brengen. Voel dus, zonder van achter uw bureau of uit uw zetel te komen, toch alvast maar de wind in de zeilen. Veel leesplezier! Maarten Falter PhD-kandidaat cardiologie, UHasselt/KU Leuven Arts-specialist in opleiding cardiologie, Jessa Ziekenhuis Secretaris Vlaamse vereniging voor Arts-Specialisten in Opleiding (VASO
Next steps in overcoming hurdles for digital health implementation in preventive cardiology
No full textnot availableDeze thesis onderzoekt de mogelijke implementatie van nieuwe digitale
gezondheidstechnologieën in de preventieve cardiologie, met een focus op
cardiale telerevalidatie. Cardiale telerevalidatie biedt oplossingen voor nadelen
van traditionele centrumgebaseerde revalidatie, zoals lage deelnamegraad en
relatief korte duur. Voor succesvolle implementatie van digitale zorgpaden moeten
barrières voor patiënten, zorgverleners en zorgsystemen worden overwonnen.
Deze thesis onderzoekt deze barrières en zoekt naar oplossingen.
Digitale gezondheid omvat technologieën zoals mobiele technologie, telemedicine
en gezondheidsinformatica. Hoewel de nadruk ligt op mobiele gezondheid en
telemedicine, wordt ook de rol van informatica besproken. In preventieve
cardiologie is er veel potentieel voor innovatie met cardiale telerevalidatie, die
aspecten zoals gemonitorde fysieke activiteit en risicofactormonitoring op afstand
omvat. Huidige barrières zijn onder andere gebrek aan patiëntmotivatie, digitale
gezondheidsvaardigheden, vertrouwen in digitale zorg, gegevensprivacy en
interoperabiliteit. Mogelijke oplossingen omvatten educatieprogramma's,
herontwerpen van werkmodellen, waarborgen van interoperabiliteit en
kennisdeling.
De thesis bestaat uit zes hoofdstukken. Hoofdstuk 1 bespreekt het huidige en
toekomstige landschap van digitale gezondheidstechnologie in preventieve
cardiologie. Hoofdstuk 2 onderzoekt de kosten-effectiviteit van cardiale
telerevalidatie. Hoofdstuk 3 richt zich op barrières voor patiënten, zoals digitale
geletterdheid. Hoofdstuk 4 beschrijft de ontwikkeling van de UHasselt Digital
Health Readiness Questionnaire. Hoofdstuk 5 onderzoekt nieuwe technologieën
zoals manchetloze bloeddrukmeters geïntegreerd in smartwatches. Hoofdstuk 6
behandelt de ontwikkeling van algoritmen voor automatische verwerking van
ongestructureerde tekstgegevens.
De discussie richt zich op de obstakels en oplossingen voor digitale
gezondheidszorg in preventieve cardiologie. Vier kernboodschappen worden
gedestilleerd: eenvoud en menselijkheid zijn cruciaal, denken in zorgpaden,
bruikbare data genereren, en het verbreden van onderzoeks-perspectieven.
Cardiale telerevalidatie biedt een oplossing voor lage participatie en beperkte duur
van conventionele revalidatie, en kan een kosteneffectieve langdurige oplossing
zijn. Het aanpakken van barrières zoals lage digitale gezondheidsvaardigheden en gebrek aan vergoeding is essentieel. Digitale interventies moeten de menselijke
connectie tussen patiënten en zorgverleners ondersteunen, vooral voor
hoogrisicopatiënten. Het doel van digitale geneeskunde is om technologie te
gebruiken voor optimale zorg, zodat patiënten veilig thuis kunnen blijven.
In de toekomst moet de samenwerking tussen zorgverleners, patiënten,
overheden en de health-tech industrie worden versterkt om een meer humane
gezondheidszorg te realiseren met behulp van technologie
Next steps in overcoming hurdles for digital health implementation in preventive cardiology
No full textnot availableDeze thesis onderzoekt de mogelijke implementatie van nieuwe digitale
gezondheidstechnologieën in de preventieve cardiologie, met een focus op
cardiale telerevalidatie. Cardiale telerevalidatie biedt oplossingen voor nadelen
van traditionele centrumgebaseerde revalidatie, zoals lage deelnamegraad en
relatief korte duur. Voor succesvolle implementatie van digitale zorgpaden moeten
barrières voor patiënten, zorgverleners en zorgsystemen worden overwonnen.
Deze thesis onderzoekt deze barrières en zoekt naar oplossingen.
Digitale gezondheid omvat technologieën zoals mobiele technologie, telemedicine
en gezondheidsinformatica. Hoewel de nadruk ligt op mobiele gezondheid en
telemedicine, wordt ook de rol van informatica besproken. In preventieve
cardiologie is er veel potentieel voor innovatie met cardiale telerevalidatie, die
aspecten zoals gemonitorde fysieke activiteit en risicofactormonitoring op afstand
omvat. Huidige barrières zijn onder andere gebrek aan patiëntmotivatie, digitale
gezondheidsvaardigheden, vertrouwen in digitale zorg, gegevensprivacy en
interoperabiliteit. Mogelijke oplossingen omvatten educatieprogramma's,
herontwerpen van werkmodellen, waarborgen van interoperabiliteit en
kennisdeling.
De thesis bestaat uit zes hoofdstukken. Hoofdstuk 1 bespreekt het huidige en
toekomstige landschap van digitale gezondheidstechnologie in preventieve
cardiologie. Hoofdstuk 2 onderzoekt de kosten-effectiviteit van cardiale
telerevalidatie. Hoofdstuk 3 richt zich op barrières voor patiënten, zoals digitale
geletterdheid. Hoofdstuk 4 beschrijft de ontwikkeling van de UHasselt Digital
Health Readiness Questionnaire. Hoofdstuk 5 onderzoekt nieuwe technologieën
zoals manchetloze bloeddrukmeters geïntegreerd in smartwatches. Hoofdstuk 6
behandelt de ontwikkeling van algoritmen voor automatische verwerking van
ongestructureerde tekstgegevens.
De discussie richt zich op de obstakels en oplossingen voor digitale
gezondheidszorg in preventieve cardiologie. Vier kernboodschappen worden
gedestilleerd: eenvoud en menselijkheid zijn cruciaal, denken in zorgpaden,
bruikbare data genereren, en het verbreden van onderzoeks-perspectieven.
Cardiale telerevalidatie biedt een oplossing voor lage participatie en beperkte duur
van conventionele revalidatie, en kan een kosteneffectieve langdurige oplossing
zijn. Het aanpakken van barrières zoals lage digitale gezondheidsvaardigheden en gebrek aan vergoeding is essentieel. Digitale interventies moeten de menselijke
connectie tussen patiënten en zorgverleners ondersteunen, vooral voor
hoogrisicopatiënten. Het doel van digitale geneeskunde is om technologie te
gebruiken voor optimale zorg, zodat patiënten veilig thuis kunnen blijven.
In de toekomst moet de samenwerking tussen zorgverleners, patiënten,
overheden en de health-tech industrie worden versterkt om een meer humane
gezondheidszorg te realiseren met behulp van technologie
Patient experiences and willingness-to-pay for cardiac telerehabilitation during the first surge of the COVID-19 pandemic: single-centre experience
No full textBackground The first surge of the ongoing COVID-19 pandemic led to a shutdown of all non-urgent medical services such as cardiac rehabilitation. Therefore, centres had to develop remote and innovative ways to deliver the core components of CR during this shutdown. This increase in usage of remote rehabilitation services provides a chance to assess patients' experiences and willingness-to-pay of remote CR sessions. Methods This was a prospective single-centre study. From 17 July 2020, to 19 August 2020, we conducted an anonymous survey about the patient experiences of the cardiac telerehabilitation services provided at Jessa Hospital Hasselt during the COVID-19 pandemic. A link to an electronic questionnaire was sent via email to 155 patients who were invited to participate in the cardiac telerehabilitation sessions during the closure of the rehabilitation centre due to COVID-19. Results Fifty-five patients (35% of all invited patients) did participate in remote CR and completed the questionnaire. The mean age of the respondents was 65.4 +/- 10.5 years, 63% were male and 70% of the participants were retired. A total of 91% possessed a smartphone and all those patients used their smartphone regularly to send text messages. Ninety-four per cent of the participants were satisfied with the provided telerehabilitation sessions and 70% of the participants would be prepared to pay for these sessions like for centre-based CR sessions. Twenty per cent of patients would even prefer the telerehabilitation sessions above centre-based CR sessions. Conclusion Most patients believed that remote CR could be an option after the COVID-19 pandemic when it is combined with centre-based CR sessions. Patients are willing to pay the same amount for a telerehabilitation session as a centre-based CR session. This demonstrates that highly motivated patients are open to shift certain parts of CR from face-to-face interactions to digital interactions.Scherrenberg, M (corresponding author), Jessa Ziekenhuis, Stadsomvaart 11, Hasselt, Belgium.
[email protected]
The future is more than a digital stethoscope
No full textWe commend the authors for the accurate overview of cardiac auscultation techniques and differential diagnoses, as well as for offering a perspective of what the future of cardiac auscultation might hold. 1 Indeed, the evolution of the digital stethoscope has been impressive in recent years. However, we believe that in cardiology and medicine in general, the future likely has more to offer than a digital stethoscope. First, one of the main strengths of telemedicine lies in patient empowerment, with patients using low-cost consumer devices themselves to screen for or monitor medical conditions. Readily available smartphones, smartwatches, wristbands, and other wearable devices are promptly transformed into medical devices through appropriate software. While not fully predictable, the real innovation in telemedi-cine will most likely be the integration and advanced analysis of all this data possibly leading to a new diagnostic paradigm, as precisely described by Krittanawong et al. 2 While cardiac acoustic data analysis or phonocardiography might certainly be part of this future, a dedicated digital artificial intelligence-assisted stethoscope is in our opinion less likely to be. Second, in the field of medicine delivered by professional caregivers, a clear evolution is taking place that is turning away from the stethoscope. With the rise and increasing accuracy of point-of-care ultrasound (POCUS), and its possibility to assess multiple organ systems, many question if the stethoscope is likely to survive the coming decades. 3,4 POCUS is replacing the stethoscope in many areas: the intensive care department, the emergency department, the internal medicine ward, and even the general practitioner's (GP) office. 5,6 Beyond cardiac evaluation and volume assessment it has shown high accuracy in evaluation of other organ systems, also when performed by GPs and emergency physicians. 7,8 A recent systematic review summarizes the results. 9 For lung pathology (e.g. pulmonary oedema, pneumonia, pneumothorax, rib fractures) accuracy was high and often superior to chest X-ray in adult as well as paediatric medicine. High accuracy was also demonstrated in diagnosing abdominal pathology (e.g. biliary pathology, appendicitis, small bowel obstruction, ascites), arterial and venous disease, guidance of catheter insertions, obstetric physiology and pathology (e.g. foetal follow-up by GPs, diagnosis of ectopic pregnancy in the emergency department). It is also used for eye examination, soft tissue examination and musculoskeletal examination; areas where the stethoscope is typically of little use. Also in rural areas, image acquisition by trained sonographers, with expert interpretation at a distance when needed, was shown feasible in the ASE-REWARD study that took place in rural India. 10 Currently POCUS is not inexpensive when compared with a stethoscope. However, many papers emphasize that, while cost is indeed a barrier, the large potential of POCUS use in low-and middle-income countries is exactly in its low cost because it can be performed by the treating physician at the point of care and, in contrast to the stethoscope , it often reduces the need for consecutive more expensive imaging modalities. 11,12 With decreasing costs of POCUS probes, increasing connectivity with smartphones and the global rollout of high-speed internet, the global usage of POCUS is thus likely to continue to grow. Time will tell what technology the future will bring and what will be implemented. The discussion that should be held today, however, is whether to continue investing large proportions of education time in training medical students to reach an expert level in (cardiac and non-cardiac) auscultation, or to opt for integrating knowledge about digital health, telemedicine and POCUS into medical education early on. In our opinion, there are many arguments to defend the latter. Conflict of interest: none declared. References 1. Jani V, Danford DA, Thompson WR, Schuster A, Manlhiot C, Kutty S. The discerning ear: cardiac auscultation in the era of artificial intelligence and telemedi-cine
Cost-effectiveness of cardiac telerehabilitation in coronary artery disease and heart failure patients: systematic review of randomized controlled trials
No full textThis systematic review aims to assess the cost-effectiveness of cardiac telerehabilitation in comparison with centre-based cardiac rehabilitation (CR). Evidence of cost-effectiveness is an important step towards implementation and reimbursement of telerehabilitation services. Electronic databases were searched for economic evaluations of telerehabilitation programmes. Only randomized controlled trials (RCTs) published in English were eligible for inclusion. Study quality and risk of bias were assessed using the Consensus Health Economic Criteria (CHEC) list. A total of eight economic evaluations met the review inclusion criteria. The total sample size consisted of 751 patients ranging from a minimum of 46 patients to a maximum of 162 patients per study. Maximal follow-up was 5 years. A total of seven of the eight included studies demonstrated that telerehabilitation could lead to similar or lower long-term costs and are thus as cost-effective as traditional centre-based CR. There is significant heterogeneity between all included telerehabilitation interventions in duration, used technology , cost included and follow-up. Based on these small short duration trials, telerehabilitation may be as cost-effective as traditional centre-based approaches. However, more assessments of the value for money of telerehabilitation in larger and longer RCTs are needed both in high-as low-income countries.Thissystematicreviewaimstoassessthecost-effectivenessofcardiactelerehabilitationincomparisonwithcentre-basedcardiacrehabilitation(CR).Evidenceofcost-effectivenessisanimportantsteptowardsimplementationandreimbursementoftelerehabilitationservices. Electronicdatabasesweresearchedforeconomicevaluationsoftelerehabilitationprogrammes.Onlyrandomizedcontrolledtrials(RCTs) publishedinEnglishwereeligibleforinclusion.StudyqualityandriskofbiaswereassessedusingtheConsensusHealthEconomicCriteria (CHEC)list.Atotalofeighteconomicevaluationsmetthereviewinclusioncriteria.Thetotalsamplesizeconsistedof751patientsrangingfromaminimumof46patientstoamaximumof162patientsperstudy.Maximalfollow-upwas5years.Atotalofsevenoftheeight includedstudiesdemonstratedthattelerehabilitationcouldleadtosimilarorlowerlong-termcostsandarethusascost-effectiveastraditionalcentre-basedCR.Thereissignificantheterogeneitybetweenallincludedtelerehabilitationinterventionsinduration,usedtechnology,costincludedandfollow-up.Basedonthesesmallshortdurationtrials,telerehabilitationmaybeascost-effectiveastraditional centre-basedapproaches.However,moreassessmentsofthevalueformoneyoftelerehabilitationinlargerandlongerRCTsareneeded bothinhigh-aslow-incomecountries
The power of movement: how physical activity can mitigate the risks of inadequate sleep
No full textThis editorial refers to 'Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry', by Y.Y. Liang et al., https://doi.org/10.1093/eurjpc/zwad060. The cardiovascular health benefits of physical activity (PA) and healthy sleep duration are well established. 1,2 In the literature, however, findings on the interaction of objectively measured PA and sleep duration have been scarce and often contradictory. 3-5 In this issue, Liang et al. provide important information about this topic through a population-based cohort study to investigate the association of accelerometer-measured PA and sleep duration with all-cause mortality, cardiovascular disease (CVD), and cancer mortality. Using the UK Biobank data, they identified 92 221 participants in whom PA and sleep duration were measured by a 7-day accelerometer recording. The results demonstrate an independent association between PA and sleep duration with mortality risk. Sleep duration (both short and long sleep duration) was associated with higher all-cause and CVD mortality. Higher moderate-to-vigorous physical activity (MVPA) was associated with a reduction of all-cause, CVD, and cancer mortality. Interestingly, the study reveals an additive and multiplicative interaction between PA and sleep duration on mortality risk. The lowest volume of PA combined with short or long sleep duration is associated with the highest risk of all-cause mortality. In contrast, a higher volume of PA seems to eliminate the risk associated with short or long sleep duration, as similar mortality risks were found in the short, normal, and long sleep duration groups.© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected]
Digital Health in Cardiac Rehabilitation and Secondary Prevention: A Search for the Ideal Tool
No full textDigital health is becoming more integrated in daily medical practice. In cardiology, patient care is already moving from the hospital to the patients’ homes, with large trials showing positive results in the field of telemonitoring via cardiac implantable electronic devices (CIEDs), monitoring of pulmonary artery pressure via implantable devices, telemonitoring via home-based non-invasive sensors, and screening for atrial fibrillation via smartphone and smartwatch technology. Cardiac rehabilitation and secondary prevention are modalities that could greatly benefit from digital health integration, as current compliance and cardiac rehabilitation participation rates are low and optimisation is urgently required. This viewpoint offers a perspective on current use of digital health technologies in cardiac rehabilitation, heart failure and secondary prevention. Important barriers which need to be addressed for implementation in medical practice are discussed. To conclude, a future ideal digital tool and integrated healthcare system are envisioned. To overcome personal, technological, and legal barriers, technological development should happen in dialog with patients and caregivers. Aided by digital technology, a future could be realised in which we are able to offer high-quality, affordable, personalised healthcare in a patient-centred way
Do we need to rethink the determination of exercise-related energy expenditure in cardiac telerehabilitation interventions?
No full textThe American College of Sports Medicine determined the energy consumption of daily activities and sports. Cardiac tele-rehabilitation (CTR) requires knowing how much energy people consume in daily life outside of cardiac rehabilitation activities. Therefore, we have investigated if the estimated values are valid in CTR. Data from two studies were incorporated. The first study measured ventilatory threshold (VT)1, VT2, and peak exercise on cardiopulmonary exercise testing (CPET) collected from 272 cardiac (risk) patients and compared them to the estimated oxygen consumption (VO 2) at low-to-moderate-intense exercise (3-6 metabolic equivalents [METs]). Next, a patient-tailored application was developed to support CTR using these estimated values, and the intervention (the second study) was conducted with 24 coronary artery disease patients using this application during a CTR intervention. In the first study, VO 2 at VT1, VT2 and peak exercise corresponded to 3.2 [2.8, 3.8], 4.3 [3.8, 5.3], and 5.4 [4.5, 6.2] METs, which are significantly different from the estimated VO 2 at low-to-moderate-intense exercise, especially lower in older, obese, female, and post-myocardial infarction/heart failure patients. These VO 2 varied considerably between patients. The telerehabilitation study did not show significant progress in peak VO 2 , but using the application's estimated target, 97.2% of the patients achieved their weekly target, which is a significant overestimate. The estimated and observed exercise-related energy expenditures by CPET were significantly different, resulting in an overestimation of the exercise done by the patients at home. The results can have a significant impact on the quantification of exercise dose during (tele)rehabilitation programs.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is partially funded by the FWO-ICA project EXPERT network (G0F4220N)
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