Farhad Fatehi

The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes

To compare the antihypertensive effectiveness of sour tea (ST; Hibiscus sabdariffa) with black tea (BT) infusion in diabetic patients, this double-blind randomized controlled trial was carried out. Sixty diabetic patients with mild hypertension, without taking antihypertensive or antihyperlipidaemic medicines, were recruited in the study. The patients were randomly allocated to the ST and BT groups and instructed to drink ST and BT infusions two times a day for 1 month. Their blood pressure (BP) was measured on days 0, 15 and 30 of the study. The mean of systolic BP (SBP) in the ST group decreased from 134.4±11.8 mm Hg at the beginning of the study to 112.7±5.7 mm Hg after 1 month (P-value <0.001), whereas this measure changed from 118.6±14.9 to 127.3±8.7 mm Hg (P-value=0.002) in the BT group during the same period. The intervention had no statistically significant effect on the mean of diastolic BP (DBP) in either the ST or BT group. The mean pulse pressure (PP) of the patients in the ST group decreased from 52.2±12.2 to 34.5±9.3 mm Hg (P-value <0.001) during the study, whereas in the BT group, it increased from 41.9±11.7 to 47.3±9.6 mm Hg (P-value=0.01). In conclusion, consuming ST infusion had positive effects on BP in type II diabetic patients with mild hypertension. This study supports the results of similar studies in which antihypertensive effects have been shown for ST.

Effects of Sour Tea (Hibiscus sabdariffa) on Lipid Profile and Lipoproteins in Patients with Type II Diabetes

OBJECTIVES There is increasing evidence that intake of sour tea (Hibiscus sabdariffa) has hypoglycemic and hypolipidemic effects and may benefit patients suffering from metabolic disorders such as diabetes. The objective of the present study was to investigate the hypolipidemic effects of sour tea in patients with diabetes and compare them with those of black tea. DESIGN In this sequential randomized controlled clinical trial, 60 patients with diabetes were recruited and randomly assigned into two groups: sour tea (ST) and black tea (BT). They were instructed to consume sour tea or black tea two times a day for 1 month. OUTCOME MEASURES Fasting blood samples were taken at the beginning and at the end of the study for evaluation of lipids, lipoproteins, and apoproteins. RESULTS Fifty-three (53) patients concluded the study. In the ST group, mean of high-density lipoprotein-cholesterol (HDLc) increased significantly (p = 0.002) at the end of the study, whereas changes in apolipoprotein-A1, and lipoprotein (a) were not significant. Also, a significant decrease in the mean of total cholesterol, low density lipoprotein-cholesterol, triglycerides, and Apo-B100 were seen in this group. In the BT group, only HDLc showed significant change (p = 0.002) at the end of the study and changes in the other measures were not statistically significant. CONCLUSIONS The results of the present study showed that ST has a significant effect on blood lipid profile in patients with diabetes.

Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews

Background Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone–based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone–based monitoring and videoconferencing, require further investigation.

Clinical applications of videoconferencing: a scoping review of the literature for the period 2002–2012:

We conducted a scoping review of the literature on the clinical applications of videoconferencing. Electronic searches were performed using the PubMed, Embase and CINHAL databases to retrieve papers published from 2002 to 2012 that described clinical applications of videoconferencing. The initial search yielded 4923 records and after removing the duplicates and screening at title/abstract level, 505 articles met the inclusion criteria and were reviewed at full-text level. The countries with the highest number of papers were the US, Australia and Canada. Most studies were non-randomised controlled trials. The discipline with highest number of published studies (39%) was mental health, followed by surgery (7%) and general medicine (6%). The type of care delivered via video comprised acute, sub-acute and chronic care, but in 44% of the papers, the intervention was used for a combination of these purposes. Videoconferencing was used for all age groups but more frequently for adults (20%). Most of the papers (91%) reported using videoconferencing for several clinical purposes including management, diagnosis, counselling and monitoring. The review showed that videoconferencing has been used in a wide range of disciplines and settings for different clinical purposes. The practical value of published papers would be improved by following standard guidelines for reporting research projects and clinical trials.

Telemedicine for clinical management of diabetes: a process analysis of video consultations

We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210–1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant’s opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists.

Mobile health (mHealth) for headache disorders: A review of the evidence base

The aim of this review was to explore and summarise the evidence base for using mobile apps for the management of headache disorders. PubMed, Web of Science, Embase and Scopus were searched for studies reporting the use of mobile health applications (apps) for managing headache disorders. Different combinations of keywords for mobile health, smartphone and headache were used for electronic search. Six studies (two journal papers and four conference papers) met the inclusion criteria and were reviewed. All of the reviewed studies were categorised as the lowest level (level IV) of evidence according to the National Health and Medical Research Council (NHMRC) hierarchy of evidence. The results of the studies demonstrated the feasibility and acceptability of a few mobile apps for headache in very limited settings, and indicated that these apps can be effective tools for identifying trigger factors of migraine, improving self-management of headache disorders, and mediating the interactions between headache sufferers and their treating doctors. The role of participatory research and involvement of patients and clinicians in the development of such apps was also highlighted. Despite the availability of numerous mobile apps for headache disorders, the evidence base to support their effectiveness and clinical safety is very weak. The current literature indicates that mobile apps have the potential for improving the care of headache sufferers, but this is yet to be proven by adequately designed studies.

Technical aspects of clinical videoconferencing: a large scale review of the literature

Summary Telemedicine has been increasingly researched during the past few decades and the technology used by health care providers and recipients has changed dramatically. However, little has been published on technical characteristics of video consultations and how these characteristics have changed over time due to rapid advancement of information and communication technology. We aimed to summarize various types of technologies used for interactive videoconferencing between health care providers and patients, and identify the trend of their change from 2002 to 2012. A comprehensive electronic search was performed using PubMed, Embase and CINAHL databases which yielded 2,411 unique records. After screening at title/abstract level, full texts of 505 articles were retrieved and explored for technical information of videoconferencing. The trend of number of publications fluctuated between 41 and 47 articles with no specific pattern, though a dip in 2004 (n = 35) and drastic increase in 2012 (n = 68) was evident. The equipment used for videoconferencing was not mentioned in 15% of the papers. Dedicated VC systems (CODECs), were the most commonly used hardware, followed by computer/laptop/notebook. The connection speed (bandwidth) was not reported in 46% of the papers. The proportion of articles reporting the connection speed declined over time. Details of image quality and frame rate were mentioned in 11% and 5% of the papers, respectively. The results of this study showed that a high proportion of telemedicine papers lack sufficient technical details that limits their repeatability and generalizability.

Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data

Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician‐supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in‐person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high‐definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web‐based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start‐up and continued uninterrupted for the remainder of the 24‐month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals.

Establishing a centralised telehealth service increases telehealth activity at a tertiary hospital

BackgroundThe Princess Alexandra Hospital Telehealth Centre (PAH-TC) is a project jointly funded by the Australian national government and Queensland Health. It seeks to provide a whole-of-hospital telehealth service using videoconferencing and store-and-forward capabilities for a range of specialities. The aim of this study was to investigate whether the introduction of a new telehealth coordination service provided by a tertiary hospital centre increased telehealth activities of a tertiary hospital. Evaluation included service delivery records and stakeholder satisfaction.MethodsTelehealth service delivery model before and after the establishment of the centre is described as well as the project implementation. The study retrieved data related to the number and scope of previous, and current, telehealth service episodes, to ascertain any change in activity levels following the introduction of the new telehealth coordination service. In addition, using a cross-sectional research design, the satisfaction of patients, clinicians and administrators was surveyed. The survey focused on technical utility and perceived clinical validity.ResultsIntroduction of a new centralised telehealth coordination service was associated with an increase in the scope of telehealth from five medical disciplines, in the year before the establishment, to 34 disciplines two years after the establishment. The telehealth consultations also increases from 412 (the year before), to 735 (one year after) and 1642 (two years after) the establishment of the centre. Respondents to the surveys included patients (27), clinicians who provided the consultations (10) and clinical or administrative staff who hosted the telehealth consultations in the remote site (8). There were high levels of agreement in relation to the telehealth option saving time and money, and an important health service delivery model. There was evidence from the remote site that modifying roles to incorporate this new service was challenging.ConclusionThe introduction of a centralised coordination for telehealth service of a tertiary hospital was associated with the increase in the scope and level of telehealth activity of the hospital. The project and model of health care delivery described in this paper can be adopted by tertiary hospitals to grow their telehealth activities, and potentially reduce costs associated with the delivery of services at a distance.

How to improve your PubMed/MEDLINE searches: 2. display settings, complex search queries and topic searching:

Summary The way that PubMed results are displayed can be changed using the Display Settings drop-down menu in the result screen. There are three groups of options: Format, Items per page and Sort by, which allow a good deal of control. The results from several searches can be temporarily stored on the Clipboard. Records of interest can be selected on the results page using check boxes and can then be combined, for example to form a reference list. The Related Citations is a valuable feature of PubMed that can provide a set of similar articles when you have identified a record of interest among the results. You can easily search for RCTs or reviews using the appropriate filters or field tags. If you are interested in clinical articles, rather than basic science or health service research, then the Clinical Queries tool on the PubMed home page can be used to retrieve them.