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    Open Access
    A new teaching model of the systemic circulation that incorporates reservoir characteristics
    (2015-02-24) Tyberg, John V.; Bouwmeester, J. C.; Burrowes, Lindsay M.; Parker, Kim H.; Shrive, Nigel G.; Wang, Jiun-Jr.
    Abstract A hydraulic teaching model of the human systemic circulation is proposed, based on the principles of the reservoir-wave approach. Reservoir characteristics are portrayed by the arterial tall-and-narrow and venous short-and-wide columns, the relative compliances of which are signified by their diameters. Wave characteristics are represented by proximal arterial and venous resistances; rapid left ventricular ejection and rapid right atrial filling cause flow-dependent pressure drops across the respective resistances. (The value of the proximal arterial resistance is numerically equal to the characteristic impedance.) The pressure drop across the proximal arterial resistance, excess pressure, is understood to be fundamentally wave-related and has been shown to be a measure of the efficiency of cardiac-vascular coupling. Excess pressure also predicts an incremental risk of cardiovascular morbidity and largely accounts for the hysteresis evidenced by an open aortic pressure-volume loop.
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    Open Access
    P27 Non-validated Blood Pressure Devices Dominate the Online Marketplace: An Initiative of the Lancet Commission on Hypertension Group
    (2020-02-17) Picone, Dean; Deshpande, Rewati; Schultz, Martin; Fonseca, Ricardo; Campbell, Norm; Delles, Christian; Hecht-Olsen, Michael; Schutte, Aletta; Stergiou, George; Angell, Sonia; Padwal, Raj; Sharman, James
    Abstract Introduction Home BP monitoring is recommended to guide clinical decisions on hypertension and is used worldwide. People make their own decisions when purchasing BP measurement devices, which are often made online. One potential barrier to accurate home BP monitoring is that patients may purchase an unvalidated device (one that has not been proven accurate according to an internationally sanctioned protocol). This study aimed to evaluate the number, type, percentage validated and cost of home BP devices available online. Methods A systematic search of online businesses selling BP devices that may be used for home BP monitoring was conducted. Multinational companies make international deliveries, so searches were restricted to BP devices available for one nation (Australia) as an example of device availability through the globally connected online marketplace. Validation status of BP devices was determined according to established protocols. Results 59 online businesses, selling 972 unique BP devices were identified. These included 278 upper-arm cuff devices (18.3% validated), 162 wrist-cuff devices (8.0% validated) and 532 wrist-band wearables (0% validated). Most BP devices (92.4%) were stocked by international ‘e-commerce’ businesses (e.g. eBay, Amazon), but only 5.5% of these were validated. Validated cuff BP devices were more expensive than non-validated devices: median (interquartile range) of 101.14 (75.00 to 151.50; versus 67.37 (30.40 to 112.83) AUD, p < 0.0001. Conclusion Non-validated BP devices dominate the online marketplace and are sold at lower cost than validated devices. The widespread use of non-validated BP devices is a barrier to accurate home BP monitoring and must be urgently addressed.
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    Open Access
    Prioritizing Patient Reported Outcome Measures (PROMs) to use in the clinical care of youth living with mental health concerns: a nominal group technique study
    (2024-02-21) Bajgain, Kalpana Thapa; Mendoza, Justino; Naqvi, Farwa; Aghajafari, Fariba; Tang, Karen; Zwicker, Jennifer; Santana, Maria-Jose
    Abstract Background In the past few decades, particularly in the mental health setting, there has been growing interest in using Patient Reported Outcome Measures (PROMs) to assess the efficacy of the treatments in healthcare systems. Despite recent initiatives for global harmonization, there remains a lack of consensus on which PROMs are best practice and appropriate. Engagement of the service users, such as patients and family members/caregivers, is vital at this stage to ensure the selected PROMs are feasible, relevant, and acceptable to them. This study aimed to prioritize PROMs by youth and family/caregiver based on feasibility, relevance, and overall importance to be used in the clinical care of youth living with anxiety and/or depression. Methods Ten validated and widely used PROMs were presented to the patients and family/caregivers. Nominal group techniques were employed to prioritize the PROMs based on feasibility, relevance, and overall importance. Results For patients and families/caregivers, the PROMs, Revised Child Anxiety and Depression Scale (RCAD 25), and The Young Person’s Core (YP-CORE) were the highest priorities. Both felt that RCAD 25 was comprehensive, short, easy, and quick to complete, whereas regarding YP-CORE, patients and family/caregivers thought it was also short and relevant. Due to some specific concerns, the Strength and Difficulties Questionnaire and Child Health Questionnaire were the lowest prioritized by patients and family/caregivers. Conclusion It is of utmost importance that patient’s and family/caregivers’ voices or opinions are considered while selecting and implementing PROMs in mental health settings. Our study provides practical recommendations around measures best suited to achieve this.
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    Open Access
    Summary of Research: What Is the True Impact of Cognitive Impairment for People Living with Multiple Sclerosis? A Commentary of Symposium Discussions at the 2020 European Charcot Foundation
    (2024-02-20) Morrow, Sarah A.; Kruger, Paola; Langdon, Dawn; Alexandri, Nektaria
    Abstract Cognitive symptoms affect disease management and activities of daily living for people living with multiple sclerosis (MS). This summary of research article summarises previously published discussions (‘What is the true impact of cognitive impairment for people living with multiple sclerosis? A commentary of symposium discussions at the 2020 European Charcot Foundation’) from the 2020 European Charcot Foundation meeting between a patient expert living with MS, a neuropsychologist and a neurologist about the impact of cognitive impairment on people living with MS. These discussions highlighted that cognitive impairment may be under-prioritised in MS care and has a substantial impact on the daily lives of people living with MS. To address this, the panel recommended improved awareness about impaired cognition in MS, improved communication between people living with MS and healthcare professionals, and routine cognition screening. This will help improve management of cognitive symptoms to maximise the quality of life of people living with MS.
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    Open Access
    Facilitators and barriers for implementing screening brief intervention and referral for health promotion in a rural hospital in Alberta: using consolidated framework for implementation research
    (2024-02-21) Mah, Sharon S.; Teare, Gary F.; Law, Jessica; Adhikari, Kamala
    Abstract Background Screening, brief intervention, and referral (SBIR) is an evidence-based, comprehensive health promotion approach commonly implemented to reduce alcohol and substance use. Implementation research on SBIR demonstrate that patients find it acceptable, reduces hospital costs, and it is effective. However, SBIR implementation in hospital settings for multiple risk factors (fruit and vegetable consumption, physical activity, alcohol and tobacco use) is still emergent. More evidence is needed to guide SBIR implementation for multiple risk factors in hospital settings. Objective To explore the facilitators and barriers of SBIR implementation in a rural hospital using the Consolidated Framework for Implementation Research (CFIR). Methods We conducted a descriptive qualitative investigation consisting of both inductive and deductive analyses. We conducted virtual, semi-structured interviews, guided by the CFIR framework. All interviews were audio-recorded, and transcribed verbatim. NVivo 12 Pro was used to organize and code the raw data. Results A total of six key informant semi-structured interviews, ranging from 45 to 60 min, were carried out with members of the implementation support team and clinical implementers. Implementation support members reported that collaborating with health departments facilitated SBIR implementation by helping (a) align health promotion risk factors with existing guidelines; (b) develop training and educational resources for clinicians and patients; and (c) foster leadership buy-in. Conversely, clinical implementers reported several barriers to SBIR implementation including, increased and disrupted workflow due to SBIR-related documentation, a lack of knowledge on patients’ readiness and motivation to change, as well as perceived patient stigma in relation to SBIR risk factors. Conclusion The CFIR provided a comprehensive framework to gauge facilitators and barriers relating to SBIR implementation. Our pilot investigation revealed that future SBIR implementation must address organizational, clinical implementer, and patient readiness to implement SBIR at all phases of the implementation process in a hospital.