[show abstract][hide abstract] ABSTRACT: To explore the experiences of patients and professionals taking part in a randomised controlled trial (RCT) of remote blood pressure (BP) telemonitoring supported by primary care. To identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice.
Qualitative study adopting a qualitative descriptive approach.
25 patients, 11 nurses and 9 doctors who were participating in an RCT of BP telemonitoring. A maximum variation sample of patients from within the trial based on age, sex and deprivation status of the practice was sought.
6 primary care practices in Scotland.
Data were collected via taped semistructured interviews. Initial thematic analysis was inductive. Multiple strategies were employed to ensure that the analysis was credible and trustworthy.
Prior to the trial, both patients and professionals were reluctant to increase the medication based on single BP measurements taken in the surgery. BP measurements based on multiple electronic readings were perceived as more accurate as a basis for action. Patients using telemonitoring became more engaged in the clinical management of their condition. Professionals reported that telemonitoring challenged existing roles and work practices and increased workload. Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback.
BP telemonitoring in a usual care setting can provide a trusted basis for medication management and improved BP control. It increases patients' engagement in the management of their condition, but supporting telemetry and greater patient engagement can increase professional workloads and demand changes in service organisation. Successful service design in practice would have to take account of how additional roles and responsibilities could be realigned with existing work and data management practices. The embedded qualitative study was included in the protocol for the HITS trial registered with ISRCTN no. 72614272.
BMJ Open 01/2013; 3(5).
Aziz Sheikh added a full-text to this article and 1 other.
[show abstract][hide abstract] ABSTRACT: Aim. To explore patients’ experiences of, views about, and need for, social support after attending a structured education programme for type 1 diabetes.
Background. Patients who attend structured education programmes attain short-term improvements in biomedical and quality-of-life measures but require support to sustain self-management principles over the longer-term. Social support can influence patients’ self-management practices; however, little is known about how programme graduates utilise other people’s help.
Design. This study was informed by the principles of grounded theory and involved concurrent data collection and analysis. Data were analysed using an inductive, thematic approach.
Methods. In-depth interviews were undertaken post-course, and 6 and 12 months later, with 30 adult patients with type 1 diabetes recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK.
Results. Patients’ preferences for social support from other people ranged from wanting minimal involvement, to benefiting from auxiliary forms of assistance, to regular monitoring and policing. New self-management skills learnt on their courses prompted and facilitated patients to seek and obtain more social support. Support received/expected from parents varied according to when patients were diagnosed, but parents’ use of outdated knowledge could act as a barrier to effective support. Support sought from others, including friends/colleagues, was informed by patients’ domestic/employment circumstances.
Conclusion. This study responds to calls for deeper understanding of the social context in which chronic illness self-management occurs. It highlights how patients can solicit and receive more social support from family members and friends after implementing self-care practices taught on education programmes.
Relevance to clinical practice. Health professionals including diabetes specialist nurses and dietitians should explore: patients’ access to and preferences for social support; how patients might be encouraged to capitalise on social support post-course; and new ways to inform/educate people within patients’ social networks.
[show abstract][hide abstract] ABSTRACT: Background:
In the last two decades, coronary artery bypass grafting (CABG) surgery has increasingly been performed without cardiopulmonary bypass (CPB) that is ‘off-pump’. A strong motivation for performing CABG surgery off-pump was to avoid CPB which has been believed to cause of cognitive decline. However, accumulating evidence from systematic reviews and meta-analyses comparing on- and off-pump CABG surgery indicate that CPB may not be the cause of cognitive decline . Several additional randomised controlled trials (RCTs) comparing cognition after on- and off-pump CABG surgery have been published since the last meta-analyses.
The aim of this study was to undertake a systematic review the literature and meta-analysis to compare cognition following on- and off-pump CABG surgery.
RCTs comparing continuous measures of cognitive outcome after on- and off-pump CABG surgery were identified by literature searching. Data extraction enabled data from seven psychometric tests (Auditory Verbal Learning Test, Grooved Pegboard, Trail-Making A and B, Digit Symbol, Digit Span, and Stroop Colour Word Test) to be amalgamated. Data was grouped into early (< six months) and late (≥ six months) postoperative periods and analysed using Revman 5.
A systematic literature search conducted in Medline, Embase, PsychINFO and The Cochrane Library yielded 13 studies totalling 2285 patients that could be included in the meta-analysis. No significant differences were found between on- and off-pump groups in any of the psychometric tests in either early or late postoperative periods.
To-date, this is the largest meta-analysis comparing cognition following on- and off-pump CABG surgery and the absence of difference is consistent with previous systematic reviews and meta-analyses. The results are highly suggestive that CPB may not be the cause cognitive decline associated with CABG surgery.