Effectiveness and Approach of Rehabilitation in Patients With Acute Heart Failure: A Review

Acute heart failure is associated with high mortality and frequent rehospitalization, resulting in enormous healthcare costs and declining physical function, activities of daily living, and quality of life. Cardiac rehabilitation has been recommended as one of the nonpharmacologic treatments for patients with heart failure. However, much of the evidence for cardiac rehabilitation interventions reported to date has been limited to chronic heart failure. In recent years, the effectiveness of rehabilitation intervention in patients with acute heart failure has been reported, led by the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial. This review overviews the recent evidence of rehabilitation in patients with acute heart failure.

Remote cardiac rehabilitation is a good alternative of outpatient cardiac rehabilitation in the COVID-19 era

BACKGROUND@#In the wake of the coronavirus disease 2019 (COVID-19) pandemic, people need to practice social distancing in order to protect themselves from SARS-CoV-2 infection. In such stressful situations, remote cardiac rehabilitation (CR) might be a viable alternative to the outpatient CR program.@*METHODS@#We prospectively investigated patients hospitalized for heart failure (HF) with a left ventricular ejection fraction of < 50%. As for patients who participated in the remote CR program, telephone support was provided by cardiologists and nurses who specialized in HF every 2 weeks after discharge. The emergency readmission rate within 30 days of discharge was compared among the outpatient CR, remote CR, and non-CR groups, and the EQ-5D score was compared between the outpatient CR and remote CR groups.@*RESULTS@#The participation rate of HF patients in our remote CR program elevated during the COVID-19 pandemic. As observed in the outpatient CR group (n = 69), the emergency readmission rate within 30 days of discharge was lower in the remote CR group (n = 30) than in the non-CR group (n = 137) (P = 0.02). The EQ-5D score was higher in the remote CR group than in the outpatient CR group (P = 0.03) 30 days after discharge.@*CONCLUSIONS@#Remote CR is as effective as outpatient CR for improving the short-term prognosis of patients hospitalized for heart failure post-discharge. This suggests that the remote CR program can be provided as a good alternative to the outpatient CR program.

The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study

PURPOSE@#Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients' homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR).@*METHODS@#All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients' homes to hospital on their participation in our OCR program.@*RESULTS@#Patients whose road distance from home to hospital was 0-10 km, 10-20 km, and 20-30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80-4.96; OR 2.98, 95% CI 2.61-3.40; and OR 1.90, 95% CI 1.61-2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001).@*CONCLUSIONS@#Using geographical analysis, we successfully evaluated the factors influencing patients' participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies.@*TRIAL REGISTRATION@#UMIN000028435.

Assessing Medical Students' Clinical Reasoning Competency Through the Simulated Case Conference / 医学教育

An oral examination using a simulated case conference format was conducted for fourth year medical students who took a practical course on clinical reasoning prior to their clinical clerkship. Although there were many disadvantages such as fewer cases and shorter testing time to use such examinations for summative purposes, we found that we could assess students' knowledge and presentation skills based on their logical reasoning. We could also comprehensively evaluate students' readiness for clerkship by applying the RIME assessment framework. We discovered the practical value of using the examination as a means of supporting learners who are facing difficulty in learning after we successfully used it to detect such learners and address their concerns. We hope that some elements of this simulated case conference can be used not only as a job preview but also as an assessment tool for pre-clinical clerkship education in other medical schools.

Potent water extracts of Indonesian medicinal plants against PTP1B

Objective: To examine the potent of water as a solvent agent in the preparation of traditional herbal medicine. Methods: Water extracts of 18 plants were prepared through reflux and examined (25 μg/mL) to evaluate their possibility for inhibiting protein tyrosine phosphatase 1B (PTP1B). The determination of IC

The Educational Effects of a Home-Visit Nursing Program on Medical Students / 医学教育

Since 2000 we have used a home-visit nursing program for fifth-year medical students at Gifu University to examine the significance of domiciliary and geriatric medicine. We used questionnaires before and after the program to evaluate its effects on students. The desire of students to be involved with both domiciliary and geriatric medicine as phys iciansincreased after the program. Greater increases were observed among students who knew less before the program about the significance of home and elder care. The program was effective for encouraging medical students to think about domiciliary and geriatric medicine.