ABSTRACT
Introduction: Injectable medicines are increasingly used to manage risk factors for cardiovascular (CV) events, such as PCSK-9 inhibitors in dyslipidaemia and GLP-1 agonists in diabetes. However, there is a paucity of data around the administrative and clinical practicalities when using these injectables, and limited information on patient and healthcare professionals' perceptions. Purpose(s): To identify the facilitators and barriers on the use of injectable therapies with CV benefits by undertaking interviews with patients, caregivers and healthcare professionals (HCPs). Method(s): Interviews were conducted via telephone and using MS Teams due to Covid-19 restrictions in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. Result(s): A total of 56 patients were interviewed: 30 in the U.K. (mean age 66 yrs, 60% male) and 26 patients in Italy (mean age 63 yrs, 80% male) and 11 caregivers (mean age 59 yrs, 73% female). A total of 38 HCPs were interviewed, 19 in each country and composed of physicians (n=18), pharmacists (n=10), nurses (n=9) and pharmacy technician (n=1). Three distinct themes were identified: (i) Organisational and governance issues - relating to prescribing restrictions and availability of the drugs locally (PCSK9i are initiated and supplied from hospitals) and lack of communication between hospital and primary care setting;(ii) Clinical issues around HCPs' skills and experience - including: Lack of experience with these injectables, lack of time to provide education to patients and caregivers, therapeutic inertia (HCPs not adopting a change in practice despite the evidence or due to bureaucratic restrictions) as well as lack of knowledge on long-term effects, and finally (iii) Patient-related issues - relating to behaviours and beliefs such as reluctance about using injectable therapies, and lack of education about these injectables in terms of indications/clinical benefits for use. Despite some differences in the prescribing of these injectables in the two countries, the analysis captured similar facilitators and barriers. Facilitators included prior use of injectables (e.g. insulin), and the ability to reach a clinical target of lower cholesterol by having just a one shot . HCPs stated that access to rapid pathology tests would aid uptake of injectables with CV benefit as well as having educational tools on these injectables in practice. Conclusion(s): This qualitative study identified barriers to initiation, continuation, and adherence with injectable therapies with CV benefits but also highlighted areas where changes can be made especially around education and support for patients and HCPs.
ABSTRACT
There is no evidence with regard to the effectiveness of the use of simulation in video conferences to facilitate the learning experiences of nursing student. Aims. To describe the research protocol 1) to validate instruments measuring student satisfaction, self-confidence, and perceptions of good planning and best practice in the use of virtual simulation in the Italian con- text on the basis of Jeffries and Rizzolo's theoretical model in the Italian context and 2) to analyse student satisfaction, self-confidence, and perceptions of good planning and best practice in virtual simulation during the COVID-19 pandemic. Methods. First, we will perform a validation study and then use a descriptive cross-sectional study design. Third year nursing students in a bachelor's degree course in nursing in central Italy, who participated in virtual simulation-based learning during the COVID-19 pandemic will be included. We will consider translation and cultural adaptation, the content and face validity, the construct validity, the criterion validity, the reliability, and the responsiveness to changes in the instruments. Then we will consider means and standard deviations for evaluating the score of the instruments. Discussion. This study will provide us with the opportunity to determine the effectiveness of virtual simulation for nursing students. The intent is not only to evaluate students' perceptions of virtual simulation but also to create a continuous monitoring system. The future intention is to evaluate the effectiveness of virtual simulation for developing students' skills during their internship. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Introduction: Cardiovascular diseases (CVD) are a major source of burden worldwide. COVID-19 pandemic has renewed the importance of remote psychoeducational interventions to improve outcomes in these patients. Technology-delivered motivational interviewing (TD-MI) has proven to be effective in chronic disease populations, yet there has been no attempt to summarize TD-MI characteristics and effectiveness in CVD populations. Methods: We searched PubMed, CINHAL, PsychInfo and Web of Science (from inception to May 1, 2021) for randomized controlled trials that enrolled adults with CVD. Record screening, data extraction and risk of bias assessment were performed in duplicate. This review is registered in PROSPERO, CRD42021241516. Results: Of the 2,742 records identified, 7 studies were eligible for qualitative synthesis. Participants (n=12,053, mean age = 62.25, 37.5% females) enrolled from community settings and prevalently affected by coronary artery disease (n. studies=5), hypertension (n=3) and heart failure (n=3), received an average of 11 phone (n=6) or video calls (n=1) over an average of 7 months. Interventionists were mostly nurses (n=4), followed by psychologists (n=2) and a social worker (n=1). Treatment fidelity was assessed in 5 trials;2 trials reported the intervention to be based on a theoretical framework, and 2 studies specified if the interventionist underwent some training before TD-MI administration. Caregivers were never involved. Most targeted outcomes were medication adherence (n=5), quality of life (n=4), disease-related parameters (n=4), and depression (n=3). Risk of bias varied markedly, with the largest source resulting from lack of blinding of participants and assessors (performance bias). The only feasible meta-analysis showed no significant effects of TDMI on depression (n=3;Z=1.18, p=0.24;I2=42%). Conclusions: The number of trials involving TD-MI interventions across CVD populations is scarce and their effectiveness is inconclusive. There was lack of reporting of interventionists' training, description of treatment fidelity, and blinding procedures. More trials with stronger designs and better reporting are needed in the CVD field to inform clinical decision making and research.