Neil J Angus

Patient focused Internet-based approaches to cardiovascular rehabilitation--a systematic review.

Cardiac rehabilitation (CR) has been shown to improve health behaviours and risk factors and the evidence suggests that home CR is as effective as hospital-based CR. Telemedicine offers the potential for more patients to engage in CR. We reviewed the evidence for patient focused Internet-based approaches to cardiovascular rehabilitation. Searches were performed in PubMed, EMBASE, Scopus and the Cochrane Controlled Trials Register. In total, nine studies involving 830 patients with heart disease that compared Internet-based cardiac rehabilitation to usual care were identified. The quality of trials was assessed using the Jadad scale. Outcome data were pooled under four subheadings: compliance; physical activity outcomes; clinical outcomes; psychosocial outcomes. Compliance rates were high but dropped over time in all studies. Physical activity measures were generally improved, as were clinical outcomes. Changes in psychosocial measures were positive, with two studies noting no change. No interventions noted a negative effect on outcomes. Despite the relatively small number of trials and the limited outcome measures, the results appeared to be positive with regard to patient outcomes and patient feedback. However, none had progressed to a clinical service.

The influence of non-modifiable illness perceptions on attendance at cardiac rehabilitation

Background: Despite the established benefits of cardiac rehabilitation (CR) attendance rates remain variable. Physical barriers to attendance have been extensively investigated but relatively less is known about the relationship between attendance at CR and psychosocial variables such as illness perceptions and social isolation. Aim: To examine the influence of socio-demographic factors, illness perceptions and social isolation on patient attendance at cardiac rehabilitation. Methods: All individuals offered CR over a two-year period were invited to take part in a postal survey. The survey collected socio-demographic data and included completion of the Friendship Scale, to assess social isolation, and the Brief Illness Perceptions Questionnaire. Parametric and non-parametric statistical tests were used as appropriate. Results: One hundred and twenty-eight (47%) questionnaires were returned. Non-attendees reported higher total illness perception scores and those who attributed their illness to non-modifiable factors were significantly less likely to attend CR (p = 0.042). Attendees reported lower levels of social isolation; however, this finding was not statistically significant. No differences were found between attendees and non-attendees in terms of their age, gender, educational status or proximity to cardiac rehabilitation centre. Conclusion: Psychosocial barriers, specifically illness perceptions and attributions, were found to be significant with patients who did not attend CR reporting more negative illness perceptions. Distance to CR was not a significant factor influencing attendance. Early screening of perceived causal attributions may help to identify those who would benefit from early and targeted intervention to increase participation in CR. Future prospective studies would permit testing of screening approaches and early interventions.

Cardiac misconceptions in healthcare workers

Background: Cardiac misconceptions are common and may have a detrimental effect on patients. Such misconceptions may be introduced or reinforced by vague and inconsistent advice from healthcare staff and can adversely affect health outcomes. Aim: To assess whether level of cardiac misconceptions significantly differs between groups of healthcare staff based on occupation. Methods: The 22-item York Cardiac Beliefs Questionnaire (YCBQ) was administered to a convenience sample of healthcare staff (n = 263) in direct contact with cardiac patients. Data was also collected on the occupation of healthcare staff and years worked. Results: Medical staff had the lowest mean score (17.5, CI 15.6–19.4), indicating fewest misconceptions, and unqualified healthcare workers had the highest mean score (32.1, CI 28.4–35.7). Analysis by ANOVA indicated differences between staff groups to be statistically significant (F = 17.66, p < 0.001). Length of time worked was found to be significantly associated with cardiac misconception score (Pearson’s r = − 0.243, p < 0.001). Further analysis demonstrated that significant differences between mean group scores remained when years worked was defined as a covariate, F = 15.68, p < 0.001). Conclusion: There is significant variability in cardiac misconceptions in different groups of healthcare staff. Education to correct cardiac misconceptions should be particularly targeted at unqualified healthcare staff. The importance of maintaining appropriate ratios of qualified to unqualified healthcare staff in the care of cardiac patients is supported by this study.

Pedagogical Innovation to Establish Partnerships in Adolescent Health Promotion: Lessons From a Scottish Undergraduate Nursing Program

Nurses have an established and expanding role in health promotion in support of public health strategies to reduce health inequalities, refocus health care on prevention, and rebalance responsibility for health toward individuals. However, evidence suggests that nurses may be unclear about the content and lack the skills to conduct health promotion. Education has been identified as an important vehicle to increase nurses’ competence and confidence in health promotion, and health promotion is a required component of undergraduate nurse education in the United Kingdom. This article presents a pedagogical innovation that enabled undergraduate student nurses in Scotland to research and rehearse health promotion to raise adolescents’ awareness of risk-taking behaviors. Student nurses completed a 2-week group-work project to develop a resource (e.g., mobile app, poster, lesson plan) targeted toward an adolescent risk behavior (e.g., self-harm, unsafe sex, alcohol misuse). The project culminated with a public “marketplace” event where students showcased their resource and obtained professional, peer, and public feedback. Opportunities afforded by the national curriculum for high school pupils enabled partnerships in adolescent health promotion to be established through involvement of pupils from a local secondary school with an interest in health care careers. School pupils participated in focus groups where students “pitched” their resource and appraised students’ work at the marketplace. This article shares the design and delivery of this project to enable replication or adaptation by health educators elsewhere and offers reflections on perceived project outcomes from the perspective of student nurses, school pupils, and nursing faculty.

Nursing knowledge of hepatitis - 25 years later

This is a survey of nurses’ and nursing students’ knowledge about hepatitis A and B and the results are compared with a similar survey of 25 years ago. Questionnaires were given to registered nurses, healthcare assistants and first and third year student nurses during May 2009. In 2009, more participants knew about the transmission of hepatitis B compared with those in 1984. However, in 1984 and 2009, there was ignorance about hepatitis B’s long incubation period and faecal-oral transmission of hepatitis A. Third year students demonstrated better understanding than first years in their knowledge of hepatitis A, B and C. It is encouraging that there has been an increase in the knowledge about hepatitis B transmission. Knowledge about hepatitis A remains poor and it is still being confused with hepatitis B. The overall knowledge about the hepatic viruses remains low and highlights an educational need among today’s nurses.

SP16 Cardiac Misconceptions in Hospital Staff

Patients and methods: Thirty-three consecutive male patients with peripheral arterial disease (main age 63.7±13.4 years) admitted in the 5th Medical Clinic of Cluj-Napoca, Romania between September 15th and November 15th, 2008 were enrolled. A standardized questionnaire (twenty questions) about the relation between some diseases and conditions (hypertension, diabetes, total cholesterol, abdominal obesity, tobacco use, family history of premature atherosclerosis etc.) and peripheral arterial disease was utilized by trained doctors to collect all data. Patients were asked to respond: “yes”, “no”, and “don’t know”. The correct (“yes” or “no”) and doubtful (“don’t know”) answers was noted. The mean number of men’s correct and doubtful answers was compared with that of thirty-three consecutive female patients (main age 64.5±9.6 years) with peripheral arterial disease admitted in the Clinic at the same time. The mean number of men’s correct and doubtful answers was then correlated with age and level of education. Results: The mean number of correct answers reported by men and women was respectively 8.2±3.2 and 7.5±4.8 (p=0,47). The mean number of doubtful answers of the two groups was respectively 6.8±4.7 and 6.8±6.7 (p=1.0). The mean number of correct answers of the sixteen men aged under 64 (median age) and seventeen men aged over 64 was 8.6±2.3 and 7.9±3.9 (p=0,60). Their mean number of doubtful answers was respectively 6.0±3.0 and 7.6±5.8 (p=0,34). The score of correct answers was 7.7±3.4 in men with primary and secondary education and 9.7±2.3 in men with postsecondary education (24 versus 9 patients, p=0.12). The mean number of doubtful answers of these two groups was respectively 7.3±5.2 and 5.4±2.6 (p=0.31). Conclusions: There were no significant differences between men and women concerning the mean number of correct and doubtful answers. Surprisingly, there were no age and education-related differences between men concerning the mean number of these answers. Romanian inpatient knowledge of the risk factors for peripheral arterial disease is poor. This may contribute to ineffective therapeutic regimen management.